Provider Demographics
NPI:1689122822
Name:PASHOVA, MARIYA NIKOLOVA
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:NIKOLOVA
Last Name:PASHOVA
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 1:1062 W BRYN MAWR AVE
Mailing Address - Street 2:APT 412
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4602
Mailing Address - Country:US
Mailing Address - Phone:773-727-9530
Mailing Address - Fax:
Practice Address - Street 1:633 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4981
Practice Address - Country:US
Practice Address - Phone:773-615-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist