Provider Demographics
NPI:1467724476
Name:KUNDINOVA, KRISTINA K (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:K
Last Name:KUNDINOVA
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 1:96-02 57TH AVENUE
Mailing Address - Street 2:10M
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-413-6039
Mailing Address - Fax:
Practice Address - Street 1:96-02 57TH AVENUE
Practice Address - Street 2:10M
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-413-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist