Provider Demographics
NPI:1609314822
Name:GEORGIEVA-WIELAND, STANISLAVA
Entity Type:Individual
Prefix:
First Name:STANISLAVA
Middle Name:
Last Name:GEORGIEVA-WIELAND
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 1:7849 78TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7444
Mailing Address - Country:US
Mailing Address - Phone:917-302-8804
Mailing Address - Fax:
Practice Address - Street 1:7849 78TH ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7444
Practice Address - Country:US
Practice Address - Phone:917-302-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency