Provider Demographics
NPI:1336876127
Name:GAYDUKOVA, LYUDMYLA
Entity Type:Individual
Prefix:
First Name:LYUDMYLA
Middle Name:
Last Name:GAYDUKOVA
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 1:311 W 24TH ST APT 10C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1567
Mailing Address - Country:US
Mailing Address - Phone:212-204-8779
Mailing Address - Fax:
Practice Address - Street 1:311 W 24TH ST APT 10C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1567
Practice Address - Country:US
Practice Address - Phone:646-263-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025856-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025856-01OtherOFFICE OF THE PROFESSIONS