Provider Demographics
NPI:1720525306
Name:MASALIGIN, FEDOSIA
Entity Type:Individual
Prefix:
First Name:FEDOSIA
Middle Name:
Last Name:MASALIGIN
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 1:13393 NE BONNEY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-8801
Mailing Address - Country:US
Mailing Address - Phone:503-539-7874
Mailing Address - Fax:
Practice Address - Street 1:306 OAK ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1719
Practice Address - Country:US
Practice Address - Phone:503-973-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist