Provider Demographics
NPI:1518265578
Name:KIMYAGAROVA, ELINA (MA, CCC/SLP, TSHH)
Entity Type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:KIMYAGAROVA
Suffix:
Gender:F
Credentials:MA, CCC/SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 146TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4301
Mailing Address - Country:US
Mailing Address - Phone:718-468-9000
Mailing Address - Fax:718-464-2017
Practice Address - Street 1:9110 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4301
Practice Address - Country:US
Practice Address - Phone:718-468-9000
Practice Address - Fax:718-464-2017
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014877-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist