Provider Demographics
NPI:1669719696
Name:STAROBINSKAYA, DIANA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:STAROBINSKAYA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:SHILMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:111 RYAN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-984-8097
Mailing Address - Fax:
Practice Address - Street 1:111 RYAN PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6370
Practice Address - Country:US
Practice Address - Phone:718-984-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherNYEIS
252Y00000XOtherSLP/CF