MEDICARE: VASILINA DAVIDOVA

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	225100000X	Physical Therapist	053210	NY

General Provider Information

NPI Number	:	1588491161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASILINA DAVIDOVA

Provider Business Mailing Address
First Line	:	8746 20TH AVE # L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4802
Country	:	US
Telephone Number	:	718-648-0888
Fax Number	:	855-955-3899

Provider Business Practice Location Address
First Line	:	3311 SHORE PKWY APT FF
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3937
Country	:	US
Telephone Number	:	718-648-0888
Fax Number	:	855-955-3899

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

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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Directions to “ VASILINA DAVIDOVA ” Practice Location

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