Provider Demographics
NPI:1518447887
Name:PETROV, ALEXANDRA (IBCLC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PETROV
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:PETROV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IBCLC
Mailing Address - Street 1:42 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4410
Mailing Address - Country:US
Mailing Address - Phone:203-962-5509
Mailing Address - Fax:
Practice Address - Street 1:42 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-962-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty