Provider Demographics
NPI:1689937765
Name:PEYSAKHOVA, SOFYA (MS ED)
Entity Type:Individual
Prefix:MS
First Name:SOFYA
Middle Name:
Last Name:PEYSAKHOVA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 AVENUE R
Mailing Address - Street 2:APT. 6C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1053
Mailing Address - Country:US
Mailing Address - Phone:917-862-4088
Mailing Address - Fax:
Practice Address - Street 1:1225 AVENUE R
Practice Address - Street 2:APT. 6C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1053
Practice Address - Country:US
Practice Address - Phone:917-862-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist