Provider Demographics
NPI:1124556030
Name:TKACHEVA, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:TKACHEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:TKACHEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IRINA'S KIDS INC
Mailing Address - Street 1:3350 NE 192ND ST # 2M-B
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2461
Mailing Address - Country:US
Mailing Address - Phone:347-217-5872
Mailing Address - Fax:
Practice Address - Street 1:3350 NE 192ND ST # 2M-B
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2461
Practice Address - Country:US
Practice Address - Phone:347-217-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1126347171174400000X
FL1342744222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT221-400-81-567-0OtherITDS