Healthcare Provider Details

I. General information

NPI: 1083907141
Provider Name (Legal Business Name): IRYNA RYCHKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11691 NE 18TH DR
NORTH MIAMI FL
33181-3278
US

IV. Provider business mailing address

11691 NE 18TH DR
NORTH MIAMI FL
33181-3278
US

V. Phone/Fax

Practice location:
  • Phone: 786-718-9599
  • Fax: 786-718-9599
Mailing address:
  • Phone: 786-718-9599
  • Fax: 786-718-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: