Provider Demographics
NPI:1194133926
Name:AVSHALUMOVA, LYUDMILA (LAC)
Entity type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:AVSHALUMOVA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 OCEAN PKWY
Mailing Address - Street 2:APT. 4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5154
Mailing Address - Country:US
Mailing Address - Phone:646-509-8983
Mailing Address - Fax:718-941-4009
Practice Address - Street 1:104-08 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-429-0545
Practice Address - Fax:718-499-1200
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist