Healthcare Provider Details

I. General information

NPI: 1215321195
Provider Name (Legal Business Name): OLGA AFONSKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WISCONSIN AVE NW
WASHINGTON DC
20016-4629
US

IV. Provider business mailing address

3627 CUMBERLAND ST NW
WASHINGTON DC
20008-2924
US

V. Phone/Fax

Practice location:
  • Phone: 202-460-7779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberNU1000000162
License Number StateDC

VIII. Authorized Official

Name: MRS. OLGA AFONSKY
Title or Position: LICENSED NUTRITIONIST
Credential: LN, CNS, MS
Phone: 202-460-7779