Provider Demographics
NPI:1972352466
Name:ZVYAGELSKY, MARIYA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARIYA
Middle Name:
Last Name:ZVYAGELSKY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 BRIDGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7210
Mailing Address - Country:US
Mailing Address - Phone:267-575-0922
Mailing Address - Fax:
Practice Address - Street 1:10160 BUSTLETON AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3749
Practice Address - Country:US
Practice Address - Phone:215-671-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029767363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology