Provider Demographics
NPI:1811331077
Name:MOLDAVSKAYA, YEVGENIYA (SLP)
Entity type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:MOLDAVSKAYA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 NEPTUNE AVE APT 17D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4308
Mailing Address - Country:US
Mailing Address - Phone:917-400-1736
Mailing Address - Fax:
Practice Address - Street 1:464 NEPTUNE AVE APT 17D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4308
Practice Address - Country:US
Practice Address - Phone:917-400-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist