Provider Demographics
NPI:1467182519
Name:OBOLENSKA, SVETLANA V
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:V
Last Name:OBOLENSKA
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 1:16805 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2317
Mailing Address - Country:US
Mailing Address - Phone:440-339-3744
Mailing Address - Fax:
Practice Address - Street 1:2727 LANCASHIRE RD APT B503
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-5526
Practice Address - Country:US
Practice Address - Phone:440-339-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6504260Medicaid