Provider Demographics
NPI:1194048900
Name:DESYATNIK, LYUBOV (HEARING AID FITTER)
Entity type:Individual
Prefix:
First Name:LYUBOV
Middle Name:
Last Name:DESYATNIK
Suffix:
Gender:F
Credentials:HEARING AID FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CRANBERRY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 CRANBERRY SQUARE DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6142
Practice Address - Country:US
Practice Address - Phone:724-778-6330
Practice Address - Fax:724-778-6317
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03092237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF03092OtherHEARING AID FITTER