Provider Demographics
NPI:1063826550
Name:KHVATIKOVA, SVETLANA (MSED)
Entity Type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:KHVATIKOVA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NEPTUNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:347-628-6971
Mailing Address - Fax:718-646-8553
Practice Address - Street 1:525 NEPTUNE AVE #12B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:347-628-6971
Practice Address - Fax:718-646-8553
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY798187131174400000X
NY798319131174400000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialist