MEDICARE: ANNA ANHELINA TRETIAKOVA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1710815378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA ANHELINA TRETIAKOVA

Provider Business Mailing Address
First Line	:	1309 JAMESTOWN RD STE 203
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3380
Country	:	US
Telephone Number	:	757-849-8170
Fax Number	:	757-271-5511

Provider Business Practice Location Address
First Line	:	1309 JAMESTOWN RD STE 203
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3380
Country	:	US
Telephone Number	:	757-849-8170
Fax Number	:	757-271-5511

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ ANNA ANHELINA TRETIAKOVA ” Practice Location

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