MEDICARE: GULNARA SELYANINA

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	174400000X	Specialist	784621131	NY
2	174400000X	Specialist	784620131	NY

General Provider Information

NPI Number	:	1902236276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GULNARA SELYANINA

Provider Business Mailing Address
First Line	:	1776 E 13TH ST APT 4K
Second Line	:	APT 4K
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1922
Country	:	US
Telephone Number	:	347-729-4383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 E 13TH ST APT 4K
Second Line	:	APT 4K
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1922
Country	:	US
Telephone Number	:	347-729-4383
Fax Number	:

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

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	12/01/2013

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Directions to “ GULNARA SELYANINA ” Practice Location

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