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NPI Code Detail

MEDICARE: MARIA NIKOLOVA DISHEVA

MEDICARE: MARIA NIKOLOVA DISHEVA
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
1235Z00000XSpeech-Language Pathologist22007613AIN

General Provider Information

NPI Number : 1265034706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA NIKOLOVA DISHEVA
Provider Business Mailing Address
First Line : 3814 E REGENTS CIR
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-7131
Country : US
Telephone Number : 808-979-5502
Fax Number :
Provider Business Practice Location Address
First Line : 2010 S YOST AVE
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-3188
Country : US
Telephone Number : 812-822-0605
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2020
Last Update Date : 11/10/2020

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Directions to “ MARIA NIKOLOVA DISHEVA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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