Provider Demographics
NPI:1083060420
Name:KALANTAROVA, YULIANA (MATERS OF ARTS)
Entity Type:Individual
Prefix:MRS
First Name:YULIANA
Middle Name:
Last Name:KALANTAROVA
Suffix:
Gender:F
Credentials:MATERS OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 64TH RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3448
Mailing Address - Country:US
Mailing Address - Phone:347-610-0883
Mailing Address - Fax:
Practice Address - Street 1:9809 64TH RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3448
Practice Address - Country:US
Practice Address - Phone:347-610-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY741828696-00Medicaid