Provider Demographics
NPI:1851602403
Name:YUNUSOVA, MARIYA (MASLPCCC)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:YUNUSOVA
Suffix:
Gender:F
Credentials:MASLPCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 67TH AVE APT 3J
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5102
Mailing Address - Country:US
Mailing Address - Phone:917-923-7910
Mailing Address - Fax:
Practice Address - Street 1:9609 67TH AVE APT 3J
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5102
Practice Address - Country:US
Practice Address - Phone:917-923-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist