Provider Demographics
NPI:1386133353
Name:GRUNIS, SVETLANA (SPED TEACHER)
Entity type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:GRUNIS
Suffix:
Gender:F
Credentials:SPED TEACHER
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:GRUNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPED TEACHER
Mailing Address - Street 1:349 MAYFAIR DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6930
Mailing Address - Country:US
Mailing Address - Phone:917-882-1494
Mailing Address - Fax:
Practice Address - Street 1:349 MAYFAIR DR S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6930
Practice Address - Country:US
Practice Address - Phone:917-882-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency