Provider Demographics
NPI:1740796739
Name:VAZURA, MARINA (MA, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:VAZURA
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13812 68TH DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1633
Mailing Address - Country:US
Mailing Address - Phone:347-828-3498
Mailing Address - Fax:
Practice Address - Street 1:5160 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1719
Practice Address - Country:US
Practice Address - Phone:718-423-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist