Provider Demographics
NPI:1326304254
Name:SHISHKIN, MARINA (MA CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:SHISHKIN
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 E 17TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3833
Mailing Address - Country:US
Mailing Address - Phone:646-829-7969
Mailing Address - Fax:
Practice Address - Street 1:1839 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2807
Practice Address - Country:US
Practice Address - Phone:646-829-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021787-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist