Provider Demographics
NPI:1255795712
Name:ILINA-LEVY, VIKTORIYA (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:VIKTORIYA
Middle Name:
Last Name:ILINA-LEVY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRADLEY PL
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3713
Mailing Address - Country:US
Mailing Address - Phone:347-415-0562
Mailing Address - Fax:
Practice Address - Street 1:100 BRADLEY PL
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3713
Practice Address - Country:US
Practice Address - Phone:347-415-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-84469174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN