Provider Demographics
NPI:1669752564
Name:PETROV, DORINA (CNA HHA)
Entity type:Individual
Prefix:MS
First Name:DORINA
Middle Name:
Last Name:PETROV
Suffix:
Gender:F
Credentials:CNA HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 ALDERTON ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2817
Mailing Address - Country:US
Mailing Address - Phone:718-568-4608
Mailing Address - Fax:718-651-1778
Practice Address - Street 1:6217 ALDERTON ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2817
Practice Address - Country:US
Practice Address - Phone:718-568-4608
Practice Address - Fax:718-651-1778
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NY343084660311R376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide