Provider Demographics
NPI:1063652782
Name:FEDYUKOVA, HANA (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:
Last Name:FEDYUKOVA
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 OCEAN AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3563
Mailing Address - Country:US
Mailing Address - Phone:917-744-3256
Mailing Address - Fax:
Practice Address - Street 1:2375 OCEAN AVE APT 6D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3563
Practice Address - Country:US
Practice Address - Phone:917-744-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist