Provider Demographics
NPI:1053851089
Name:MANASHIROVA, LYUBOV
Entity Type:Individual
Prefix:
First Name:LYUBOV
Middle Name:
Last Name:MANASHIROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 COYLE ST
Mailing Address - Street 2:APT 309
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1748
Mailing Address - Country:US
Mailing Address - Phone:347-989-5971
Mailing Address - Fax:
Practice Address - Street 1:2815 COYLE ST
Practice Address - Street 2:APT 309
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1748
Practice Address - Country:US
Practice Address - Phone:347-989-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY725911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse