Provider Demographics
NPI:1205133691
Name:LEVASHOV, NATALIYA
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:LEVASHOV
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 1:10200 SHORE FRONT PKWY
Mailing Address - Street 2:APT # 9L
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2787
Mailing Address - Country:US
Mailing Address - Phone:718-690-0272
Mailing Address - Fax:
Practice Address - Street 1:999 CENTRAL AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1205
Practice Address - Country:US
Practice Address - Phone:516-374-7915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016554171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor