Provider Demographics
NPI:1912327982
Name:MULLOKANDOVA, SVETLANA
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:MULLOKANDOVA
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 1:6544 SAUNDERS ST APT D1
Mailing Address - Street 2:REGO PARK
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4208
Mailing Address - Country:US
Mailing Address - Phone:347-345-5872
Mailing Address - Fax:
Practice Address - Street 1:6544 SAUNDERS ST APT D1
Practice Address - Street 2:REGO PARK
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4208
Practice Address - Country:US
Practice Address - Phone:347-345-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004930-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant