Provider Demographics
NPI:1881377125
Name:SUKHORUKOV, ELENA (NMD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:SUKHORUKOV
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 E PLAZA CIR UNIT 1888
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-7675
Mailing Address - Country:US
Mailing Address - Phone:619-894-9804
Mailing Address - Fax:
Practice Address - Street 1:591 E PLAZA CIR UNIT 1888
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-7675
Practice Address - Country:US
Practice Address - Phone:619-894-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23-1789175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath