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Organization
VIOLLETA FUZAYLOV, INC
Active
Organization
VIOLLETA FUZAYLOV, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIOLLETA FUZAYLOV MS CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(347) 738-1197
Entity
Organization
Contact information
Practice address
6511 BOOTH ST, STE 1 C, REGO PARK, NY 11374-4181
(347) 808-7196
Mailing address
6511 BOOTH ST, STE 1 C, REGO PARK, NY 11374-4181
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
019822
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12249983
CAQH ID
NY
Enumeration date
09/13/2011
Last updated
09/13/2011
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