Provider Demographics
NPI:1780945758
Name:MYAKSHIN, VADIM A (MS ED)
Entity type:Individual
Prefix:MR
First Name:VADIM
Middle Name:A
Last Name:MYAKSHIN
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 AVENUE R
Mailing Address - Street 2:APT 4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2853
Mailing Address - Country:US
Mailing Address - Phone:718-676-2440
Mailing Address - Fax:718-676-2440
Practice Address - Street 1:1310 AVENUE R
Practice Address - Street 2:APT 4C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2853
Practice Address - Country:US
Practice Address - Phone:718-676-2440
Practice Address - Fax:718-676-2440
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist