Provider Demographics
NPI:1538484530
Name:GANAS-ISMAKOV, EVELINA (MS)
Entity Type:Individual
Prefix:MRS
First Name:EVELINA
Middle Name:
Last Name:GANAS-ISMAKOV
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2511
Mailing Address - Country:US
Mailing Address - Phone:917-360-8302
Mailing Address - Fax:
Practice Address - Street 1:1748 E 27TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2511
Practice Address - Country:US
Practice Address - Phone:917-360-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist