Healthcare Provider Details

I. General information

NPI: 1609770395
Provider Name (Legal Business Name): IRYNA KUSHYK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 SE 17TH ST STE A
FORT LAUDERDALE FL
33316-1727
US

IV. Provider business mailing address

1425 SE 17TH ST STE A
FORT LAUDERDALE FL
33316-1727
US

V. Phone/Fax

Practice location:
  • Phone: 678-643-8914
  • Fax:
Mailing address:
  • Phone: 678-643-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOS6639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: