Provider Demographics
NPI:1952041543
Name:DUBANYCH, TETIANA (MS ED)
Entity Type:Individual
Prefix:
First Name:TETIANA
Middle Name:
Last Name:DUBANYCH
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 1:2955 BRIGHTON 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8533
Mailing Address - Country:US
Mailing Address - Phone:929-435-7780
Mailing Address - Fax:
Practice Address - Street 1:1702 W 7TH ST APT ME
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1308
Practice Address - Country:US
Practice Address - Phone:929-435-7780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1451514201252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency