Provider Demographics
NPI:1477811487
Name:ZAVULUNOV, MARINA (TSSLD)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:ZAVULUNOV
Suffix:
Gender:F
Credentials:TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 15TH AVE
Mailing Address - Street 2:APT. 3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5609 15TH AVE
Practice Address - Street 2:APT. 3G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4749
Practice Address - Country:US
Practice Address - Phone:646-552-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist