Provider Demographics
NPI:1922644707
Name:BAKUNOVA, ANIA (MS CCC-SLP TSSLD BE)
Entity type:Individual
Prefix:
First Name:ANIA
Middle Name:
Last Name:BAKUNOVA
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PARK PL APT 4C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3378
Mailing Address - Country:US
Mailing Address - Phone:646-281-5946
Mailing Address - Fax:
Practice Address - Street 1:145 PARK PL APT 4C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3378
Practice Address - Country:US
Practice Address - Phone:646-281-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-315120174N00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN