Provider Demographics
NPI:1801364955
Name:LEVITSKIY, VALENTINA
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:LEVITSKIY
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 1:3640 CLINTON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MC GRAW
Mailing Address - State:NY
Mailing Address - Zip Code:13101-9443
Mailing Address - Country:US
Mailing Address - Phone:607-591-3184
Mailing Address - Fax:
Practice Address - Street 1:3640 CLINTON STREET EXT
Practice Address - Street 2:
Practice Address - City:MC GRAW
Practice Address - State:NY
Practice Address - Zip Code:13101-9443
Practice Address - Country:US
Practice Address - Phone:607-591-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical