Provider Demographics
NPI:1851769657
Name:DAVYDOV, OKSANA
Entity Type:Individual
Prefix:
First Name:OKSANA
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 1:6612 102ND ST
Mailing Address - Street 2:APT 4C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4521
Mailing Address - Country:US
Mailing Address - Phone:917-502-8845
Mailing Address - Fax:
Practice Address - Street 1:6612 102ND ST
Practice Address - Street 2:APT 4C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4521
Practice Address - Country:US
Practice Address - Phone:917-502-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3548230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist