MEDICARE: SUSANNA BABAYEV

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	235500000X	Speech/Language/Hearing Specialist/Technologist	3775524	NY

General Provider Information

NPI Number	:	1780401604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA BABAYEV

Provider Business Mailing Address
First Line	:	7020 AVENUE U APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6146
Country	:	US
Telephone Number	:	917-420-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 AVENUE U APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6146
Country	:	US
Telephone Number	:	917-420-1904
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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Directions to “ SUSANNA BABAYEV ” Practice Location

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