Provider Demographics
NPI:1326731340
Name:KRIVOSHAEV, MARIANNA
Entity Type:Individual
Prefix:MS
First Name:MARIANNA
Middle Name:
Last Name:KRIVOSHAEV
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 1:40-03 201ST STREET
Mailing Address - Street 2:B
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361
Mailing Address - Country:US
Mailing Address - Phone:347-409-2651
Mailing Address - Fax:
Practice Address - Street 1:20507 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2222
Practice Address - Country:US
Practice Address - Phone:347-409-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist