Provider Demographics
NPI:1013637370
Name:RA, EUNA VERONICA
Entity Type:Individual
Prefix:
First Name:EUNA
Middle Name:VERONICA
Last Name:RA
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 1:65 SOUNDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1112
Mailing Address - Country:US
Mailing Address - Phone:718-704-9939
Mailing Address - Fax:
Practice Address - Street 1:3555 223RD ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2236
Practice Address - Country:US
Practice Address - Phone:718-428-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist