Provider Demographics
NPI:1528866753
Name:ANYA LLC
Entity type:Organization
Organization Name:ANYA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAZHANSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:646-417-0262
Mailing Address - Street 1:6805 RUNKLES RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7319
Mailing Address - Country:US
Mailing Address - Phone:646-417-0262
Mailing Address - Fax:240-202-4105
Practice Address - Street 1:205 EAST RIDGEVILLE BLVD
Practice Address - Street 2:2ND LEVEL
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-2177
Practice Address - Country:US
Practice Address - Phone:240-394-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty