Provider Demographics
NPI:1760006456
Name:ESHAK, MARINA (MS)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:ESHAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N ASHLEY DR UNIT 1208
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4367
Mailing Address - Country:US
Mailing Address - Phone:219-588-0428
Mailing Address - Fax:
Practice Address - Street 1:4915 S WEST SHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3329
Practice Address - Country:US
Practice Address - Phone:813-380-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17538235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist