Healthcare Provider Details

I. General information

NPI: 1235161084
Provider Name (Legal Business Name): OLGA SELIKHOV APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLGA STORONKIN APRN

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HEMLOCK POINT DR
COVENTRY CT
06238-2336
US

IV. Provider business mailing address

125 HEMLOCK POINT DR
COVENTRY CT
06238-2336
US

V. Phone/Fax

Practice location:
  • Phone: 860-977-6281
  • Fax: 860-724-2346
Mailing address:
  • Phone: 860-977-6281
  • Fax: 860-724-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003094
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003094
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: