Individual
AVITAL YUSHUVAEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3391 RICHMOND AVE, STATEN ISLAND, NY 10312-2025
(718) 608-9170
Mailing address
6260 108TH ST APT 3G, FOREST HILLS, NY 11375-1302
(347) 248-9049
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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