Provider Demographics
NPI:1417414640
Name:GAYDASH, OKSANA
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:GAYDASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHORE BLVD APT 3H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4023
Mailing Address - Country:US
Mailing Address - Phone:347-282-3725
Mailing Address - Fax:
Practice Address - Street 1:10 SHORE BLVD APT 6L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4027
Practice Address - Country:US
Practice Address - Phone:347-282-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY953362151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist