Provider Demographics
NPI:1699104588
Name:SHVABSKAYA, IRINA (MS, ED)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:SHVABSKAYA
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 WOODCUTTERS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6150
Mailing Address - Country:US
Mailing Address - Phone:347-934-3582
Mailing Address - Fax:
Practice Address - Street 1:79 WOODCUTTERS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-6150
Practice Address - Country:US
Practice Address - Phone:347-934-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY571999111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist