Provider Demographics
NPI:1245580083
Name:STARAYEVA, MILANA
Entity Type:Individual
Prefix:
First Name:MILANA
Middle Name:
Last Name:STARAYEVA
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 1:6536 99TH ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4302
Mailing Address - Country:US
Mailing Address - Phone:347-251-4203
Mailing Address - Fax:
Practice Address - Street 1:6536 99TH ST APT 3J
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4302
Practice Address - Country:US
Practice Address - Phone:347-251-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017494-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist