Provider Demographics
NPI:1407202880
Name:KANEVSKAYA, IRINA (SLP)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KANEVSKAYA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CONKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1342
Mailing Address - Country:US
Mailing Address - Phone:718-344-9028
Mailing Address - Fax:
Practice Address - Street 1:76 CONKLIN AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1342
Practice Address - Country:US
Practice Address - Phone:718-344-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist