Provider Demographics
NPI:1871865337
Name:ISAKHAROVA, BELLA (SLP)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:ISAKHAROVA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9611 65TH RD
Mailing Address - Street 2:501
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4158
Mailing Address - Country:US
Mailing Address - Phone:917-650-3136
Mailing Address - Fax:
Practice Address - Street 1:9611 65TH RD
Practice Address - Street 2:501
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4158
Practice Address - Country:US
Practice Address - Phone:917-650-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019234-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist