Provider Demographics
NPI:1578052478
Name:ZADOYANNAYA, VIRA
Entity Type:Individual
Prefix:
First Name:VIRA
Middle Name:
Last Name:ZADOYANNAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHAMBER VALLEY ESTS
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9301
Mailing Address - Country:US
Mailing Address - Phone:585-576-0808
Mailing Address - Fax:
Practice Address - Street 1:11 CHAMBER VALLEY ESTS
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-9301
Practice Address - Country:US
Practice Address - Phone:585-576-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642745-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid