Provider Demographics
NPI:1528595907
Name:OVSIY, OLEXANDRA
Entity Type:Individual
Prefix:
First Name:OLEXANDRA
Middle Name:
Last Name:OVSIY
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 1:751 OAK ST STE 601
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3373
Mailing Address - Country:US
Mailing Address - Phone:646-404-4309
Mailing Address - Fax:
Practice Address - Street 1:751 OAK ST STE 601
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3373
Practice Address - Country:US
Practice Address - Phone:904-354-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060060122300000X, 1223G0001X
390200000X
FLDN23229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528595807Medicaid