Provider Demographics
NPI:1003458225
Name:GAYEVSKAYA, SVETLANA A
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:A
Last Name:GAYEVSKAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SVETLANA
Other - Middle Name:ANATDLYEVNA
Other - Last Name:TRIKOZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 14123
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082
Mailing Address - Country:US
Mailing Address - Phone:425-737-8885
Mailing Address - Fax:
Practice Address - Street 1:12605 E. GIBSON RD. UNIT # 87
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204
Practice Address - Country:US
Practice Address - Phone:425-737-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider