Provider Demographics
NPI:1215418074
Name:SHAKHBAZOV, ANNA (MS-CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:SHAKHBAZOV
Suffix:
Gender:F
Credentials:MS-CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 BRAGG ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5459
Mailing Address - Country:US
Mailing Address - Phone:917-496-8351
Mailing Address - Fax:
Practice Address - Street 1:1560 MAYFLOWER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5400
Practice Address - Country:US
Practice Address - Phone:718-948-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist