Provider Demographics
NPI:1801141965
Name:STAVREVA, RUMYANKA
Entity type:Individual
Prefix:
First Name:RUMYANKA
Middle Name:
Last Name:STAVREVA
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 1:7 BROOKSIDE DR E
Mailing Address - Street 2:APT Q
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 BROOKSIDE DR E
Practice Address - Street 2:APT Q
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3033
Practice Address - Country:US
Practice Address - Phone:347-843-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576566163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care