Provider Demographics
NPI:1174038509
Name:BOLDIN, SVETLANA (BS)
Entity Type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:BOLDIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 W 5TH ST APT D10
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1474
Mailing Address - Country:US
Mailing Address - Phone:347-559-9367
Mailing Address - Fax:
Practice Address - Street 1:100 W 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4618
Practice Address - Country:US
Practice Address - Phone:212-579-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627457163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty