Healthcare Provider Details

I. General information

NPI: 1982450797
Provider Name (Legal Business Name): NATALIA SNIGURSKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 STATE ROAD 312
ST AUGUSTINE FL
32086-4241
US

IV. Provider business mailing address

240 STATE ROAD 312
ST AUGUSTINE FL
32086-4241
US

V. Phone/Fax

Practice location:
  • Phone: 312-818-0891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN29044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: