Provider Demographics
NPI:1679298053
Name:DAVYDOV, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DAVYDOV
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 1:13924 PERSHING CRES
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1949
Mailing Address - Country:US
Mailing Address - Phone:646-610-3938
Mailing Address - Fax:
Practice Address - Street 1:13924 PERSHING CRES
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1949
Practice Address - Country:US
Practice Address - Phone:646-610-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist