MEDICARE: YEVGENIYA MOLDAVSKAYA 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

General Provider Information

NPI Number	:	1811331077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIYA MOLDAVSKAYA SLP

Provider Business Mailing Address
First Line	:	464 NEPTUNE AVE APT 17D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4308
Country	:	US
Telephone Number	:	917-400-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 NEPTUNE AVE APT 17D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4308
Country	:	US
Telephone Number	:	917-400-1736
Fax Number	:

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

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	04/18/2013

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