Provider Demographics
NPI:1134363807
Name:FAYZIYEV, SVETLANA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:FAYZIYEV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 153RD ST
Mailing Address - Street 2:APARTMENT # 331
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3090
Mailing Address - Country:US
Mailing Address - Phone:718-793-6382
Mailing Address - Fax:
Practice Address - Street 1:7525 153RD ST
Practice Address - Street 2:APARTMENT # 331
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3090
Practice Address - Country:US
Practice Address - Phone:718-793-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678433222252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency