MEDICARE: BIANA DOLZHANSKAYA 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	030751	NY

General Provider Information

NPI Number	:	1649969981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANA DOLZHANSKAYA CCC-SLP

Provider Business Mailing Address
First Line	:	1776 E 13TH ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1951
Country	:	US
Telephone Number	:	917-648-0126
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 E 13TH ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1951
Country	:	US
Telephone Number	:	917-648-0126
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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