Healthcare Provider Details

I. General information

NPI: 1346073053
Provider Name (Legal Business Name): NADIA DAVIDENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N 24TH AVE APT 4303
HOLLYWOOD FL
33020-1451
US

IV. Provider business mailing address

2900 N 24TH AVE APT 4303
HOLLYWOOD FL
33020-1451
US

V. Phone/Fax

Practice location:
  • Phone: 954-397-9728
  • Fax:
Mailing address:
  • Phone: 954-397-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: