Healthcare Provider Details

I. General information

NPI: 1225957590
Provider Name (Legal Business Name): AVIGAIL HANNA BACHAYEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11506 ROCKAWAY BEACH BLVD
FAR ROCKAWAY NY
11694-2346
US

IV. Provider business mailing address

6812 YELLOWSTONE BLVD APT 6W
FOREST HILLS NY
11375-3248
US

V. Phone/Fax

Practice location:
  • Phone: 718-554-7766
  • Fax:
Mailing address:
  • Phone: 917-841-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: