Provider Demographics
NPI:1689141707
Name:SHUBA, NATALLIA SERGEEVNA
Entity Type:Individual
Prefix:
First Name:NATALLIA
Middle Name:SERGEEVNA
Last Name:SHUBA
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 1:2246 OCEAN AVE APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2210
Mailing Address - Country:US
Mailing Address - Phone:917-832-3223
Mailing Address - Fax:
Practice Address - Street 1:2246 OCEAN AVE APT 5F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2210
Practice Address - Country:US
Practice Address - Phone:917-832-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst