Provider Demographics
NPI:1093399578
Name:SEMENOVA, VALERIYA
Entity Type:Individual
Prefix:
First Name:VALERIYA
Middle Name:
Last Name:SEMENOVA
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 1:16 FAIRLAWN LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3509
Mailing Address - Country:US
Mailing Address - Phone:646-675-4415
Mailing Address - Fax:
Practice Address - Street 1:16 FAIRLAWN LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3509
Practice Address - Country:US
Practice Address - Phone:646-675-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered