Provider Demographics
NPI:1942405394
Name:DUSHUK, GALINA S (NP)
Entity Type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:S
Last Name:DUSHUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0390
Mailing Address - Fax:
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-922-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304636363L00000X
NYF304636-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131126/RGHMedicaid
NY03318334Medicaid
NY01131126/RGHMedicaid
NY70005A/RGHMedicare PIN