Healthcare Provider Details

I. General information

NPI: 1598021594
Provider Name (Legal Business Name): SVETLANA VALEVSKI D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LANA VALEVSKI D.O.M.

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 SE CENTRAL PKWY
STUART FL
34994-3904
US

IV. Provider business mailing address

2336 SE OCEAN BLVD #215
STUART FL
34996-3310
US

V. Phone/Fax

Practice location:
  • Phone: 772-800-6744
  • Fax:
Mailing address:
  • Phone: 561-247-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: