Provider Demographics
NPI:1336812338
Name:ASTASHKA, MARYNA
Entity Type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:ASTASHKA
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 1:79 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-2413
Mailing Address - Country:US
Mailing Address - Phone:860-656-8485
Mailing Address - Fax:
Practice Address - Street 1:79 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-2413
Practice Address - Country:US
Practice Address - Phone:860-656-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT127331163W00000X
CT12013367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered