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General NPI Number Information
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NPI Number | 1710541495
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Entity Type | Individual
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Provider Name | MARIYA DINEVA PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/27/2019
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 375 JAY ST
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City | BROOKLYN
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State | NY
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Zip | 11201-3200
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Country | US
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Telephone | 718-514-7876
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Fax |
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Provider Business Mailing Address
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Address Line | 1853 PUTNAM AVE APT 3L
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4320
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Country | US
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Telephone | 646-403-6070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 023488
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA66639
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License Number State | CA
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