Provider Demographics
NPI:1518248343
Name:BUDILOVSKAYA, TANYA (CFY-SLP)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:BUDILOVSKAYA
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:MS
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:BUDILOVSKAYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFY-SLP
Mailing Address - Street 1:711 MONTAUK CT
Mailing Address - Street 2:#3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5157
Mailing Address - Country:US
Mailing Address - Phone:718-676-5969
Mailing Address - Fax:
Practice Address - Street 1:711 MONTAUK CT
Practice Address - Street 2:#3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5157
Practice Address - Country:US
Practice Address - Phone:718-676-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1162982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist