Provider Demographics
NPI:1912314329
Name:TSYNDRA, OXANA
Entity Type:Individual
Prefix:
First Name:OXANA
Middle Name:
Last Name:TSYNDRA
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 1:6505 CENTRAL AVE
Mailing Address - Street 2:APT. 4J
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6201
Mailing Address - Country:US
Mailing Address - Phone:347-889-6375
Mailing Address - Fax:
Practice Address - Street 1:6505 CENTRAL AVE
Practice Address - Street 2:APT. 4J
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6201
Practice Address - Country:US
Practice Address - Phone:347-889-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057557183500000X
NJ28RI03397600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist