Healthcare Provider Details

I. General information

NPI: 1336664986
Provider Name (Legal Business Name): IRINA NOVIKOVA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

9851 SUNSET BAY WAY APT 206
ORLANDO FL
32821-8870
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1050
  • Fax:
Mailing address:
  • Phone: 720-338-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: