MEDICARE: MS. ELENA MALEVANAYA M.S. MHC

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1225451719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELENA MALEVANAYA M.S. MHC

Provider Business Mailing Address
First Line	:	8100 SHORE FRONT PKWY APT 8F
Second Line	:
City	:	ROCKAWAY BEACH
State	:	NY
Zip	:	11693-2116
Country	:	US
Telephone Number	:	347-840-0546
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 SHORE FRONT PKWY APT 8F
Second Line	:
City	:	ROCKAWAY BEACH
State	:	NY
Zip	:	11693-2116
Country	:	US
Telephone Number	:	347-840-0546
Fax Number	:

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

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	02/04/2014

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