Provider Demographics
NPI:1205246303
Name:BIASSONAVA, DARYA
Entity type:Individual
Prefix:
First Name:DARYA
Middle Name:
Last Name:BIASSONAVA
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 1:3130 BRIGHTON 6TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6946
Mailing Address - Country:US
Mailing Address - Phone:347-424-8662
Mailing Address - Fax:
Practice Address - Street 1:3130 BRIGHTON 6TH ST APT 4E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6946
Practice Address - Country:US
Practice Address - Phone:347-424-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1352516390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program