Provider Demographics
NPI:1356640734
Name:DENISSOVA, SVETLANA I (MSC)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:I
Last Name:DENISSOVA
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 E NEWPORT CENTER DR
Mailing Address - Street 2:RADIATION ONCOLOGY
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7753
Mailing Address - Country:US
Mailing Address - Phone:954-698-3690
Mailing Address - Fax:954-698-3693
Practice Address - Street 1:1192 E NEWPORT CENTER DR
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7753
Practice Address - Country:US
Practice Address - Phone:954-698-3690
Practice Address - Fax:954-698-3693
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPR299247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist