Provider Demographics
NPI:1073363313
Name:MANUKYAN, GAYANE
Entity Type:Individual
Prefix:
First Name:GAYANE
Middle Name:
Last Name:MANUKYAN
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 1:8 KALAMAT FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1656
Mailing Address - Country:US
Mailing Address - Phone:312-391-5181
Mailing Address - Fax:
Practice Address - Street 1:338 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1696
Practice Address - Country:US
Practice Address - Phone:508-770-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist