Provider Demographics
NPI:1841606514
Name:VISHNEVSKY, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:VISHNEVSKY
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 1:5337 GREENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3059
Mailing Address - Country:US
Mailing Address - Phone:718-640-7917
Mailing Address - Fax:
Practice Address - Street 1:405 COMMERCIAL CT STE A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1653
Practice Address - Country:US
Practice Address - Phone:941-484-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist