Provider Demographics
NPI:1386831337
Name:GLADOUN, SVETLANA (DO)
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:GLADOUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2807
Mailing Address - Country:US
Mailing Address - Phone:718-891-1551
Mailing Address - Fax:718-891-1281
Practice Address - Street 1:1839 E 13TH ST FL GOOD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2807
Practice Address - Country:US
Practice Address - Phone:718-891-1551
Practice Address - Fax:718-891-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258075208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY258075OtherLICENSE