Provider Demographics
NPI:1366089682
Name:SLUBERSKI, CRISTIE LYNN (MSED)
Entity type:Individual
Prefix:MRS
First Name:CRISTIE
Middle Name:LYNN
Last Name:SLUBERSKI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:CRISTIE
Other - Middle Name:LYNN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:5871 GROVELAND STATION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-9767
Mailing Address - Country:US
Mailing Address - Phone:585-658-4023
Mailing Address - Fax:
Practice Address - Street 1:5871 GROVELAND STATION RD
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-9767
Practice Address - Country:US
Practice Address - Phone:585-658-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3615685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3615685OtherNEW YORK STATE OF EDUCATION