Provider Demographics
NPI:1972865681
Name:VLADOVA, TATYANA (MS SP ED)
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:VLADOVA
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 CENTER BLVD
Mailing Address - Street 2:#907
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5738
Mailing Address - Country:US
Mailing Address - Phone:646-824-6716
Mailing Address - Fax:
Practice Address - Street 1:4615 CENTER BLVD
Practice Address - Street 2:#907
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5738
Practice Address - Country:US
Practice Address - Phone:646-824-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1319149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist