Provider Demographics
NPI:1821311085
Name:SHASHKOVA, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SHASHKOVA
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 1:3611 HENRY HUDSON PKWY
Mailing Address - Street 2:APT. 1C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1545
Mailing Address - Country:US
Mailing Address - Phone:646-496-6959
Mailing Address - Fax:
Practice Address - Street 1:2885 MARION AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3012
Practice Address - Country:US
Practice Address - Phone:718-584-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist