MEDICARE: IRINA TKACHEVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	1342744	FL
2	174400000X	Specialist	1126347171	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T221-400-81-567-0	OTHER	FL	ITDS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124556030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA TKACHEVA

Provider Business Mailing Address
First Line	:	3350 NE 192ND ST # 2M-B
Second Line	:
City	:	AVENTURA
State	:	FL
Zip	:	33180-2461
Country	:	US
Telephone Number	:	347-217-5872
Fax Number	:

Provider Business Practice Location Address
First Line	:	2477 WEST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5917
Country	:	US
Telephone Number	:	347-217-5872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	01/06/2025

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Directions to “ IRINA TKACHEVA ” Practice Location

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