Provider Demographics
NPI:1740524685
Name:SIYUNOVA, ALENA (MSED)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:SIYUNOVA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10860 66TH AVE # B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2242
Mailing Address - Country:US
Mailing Address - Phone:718-724-4883
Mailing Address - Fax:718-530-6613
Practice Address - Street 1:10860 66TH AVENUE
Practice Address - Street 2:# B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2242
Practice Address - Country:US
Practice Address - Phone:718-724-4883
Practice Address - Fax:718-530-6613
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2295133252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency