Provider Demographics
NPI:1205021979
Name:PERRY, SVETLANA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 BANNER AVE
Mailing Address - Street 2:APT 4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6755
Mailing Address - Country:US
Mailing Address - Phone:347-216-2397
Mailing Address - Fax:
Practice Address - Street 1:2212 PLUMB 1ST ST APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5763
Practice Address - Country:US
Practice Address - Phone:347-216-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17587100163W00000X
NY0032251171100000X
NY685413163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist