Provider Demographics
NPI:1235161084
Name:SELIKHOV, OLGA (APRN)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:SELIKHOV
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:STORONKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:995 DAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1722
Mailing Address - Country:US
Mailing Address - Phone:860-679-3364
Mailing Address - Fax:
Practice Address - Street 1:433 VALLEY ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1901
Practice Address - Country:US
Practice Address - Phone:860-456-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003094363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400003094CT03OtherPROVIDER NUMBER
CT500001582Medicare ID - Type UnspecifiedPROVIDER NUMBER