Provider Demographics
NPI:1154435311
Name:AVSHALUMOVA, GYULNARA (PT, MS)
Entity type:Individual
Prefix:MRS
First Name:GYULNARA
Middle Name:
Last Name:AVSHALUMOVA
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3534
Mailing Address - Country:US
Mailing Address - Phone:718-966-7462
Mailing Address - Fax:
Practice Address - Street 1:281 PORT RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1707
Practice Address - Country:US
Practice Address - Phone:917-697-2617
Practice Address - Fax:718-966-7462
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist