MEDICARE: MRS. YELENA KHASHCHEVATSKAYA CCC-SLP

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	235Z00000X	Speech-Language Pathologist	014874	NY

General Provider Information

NPI Number	:	1326280215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YELENA KHASHCHEVATSKAYA CCC-SLP

Provider Business Mailing Address
First Line	:	355 CLEVELAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3402
Country	:	US
Telephone Number	:	917-293-2238
Fax Number	:	718-948-0322

Provider Business Practice Location Address
First Line	:	355 CLEVELAND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3402
Country	:	US
Telephone Number	:	917-293-2238
Fax Number	:	718-948-0322

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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