Provider Demographics
NPI:1467699322
Name:MATAYEV, MAZAL MARGARITA (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAZAL
Middle Name:MARGARITA
Last Name:MATAYEV
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 179TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1603
Mailing Address - Country:US
Mailing Address - Phone:171-896-9777
Mailing Address - Fax:
Practice Address - Street 1:7323 179TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1603
Practice Address - Country:US
Practice Address - Phone:171-896-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist