Provider Demographics
NPI:1255487153
Name:GVOZDEVSKIY, ANDREY
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:GVOZDEVSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 RAYNOR CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6860
Mailing Address - Country:US
Mailing Address - Phone:757-471-6215
Mailing Address - Fax:
Practice Address - Street 1:609 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7336
Practice Address - Country:US
Practice Address - Phone:757-431-6617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other