Healthcare Provider Details

I. General information

NPI: 1710506910
Provider Name (Legal Business Name): NATALIYA BUKAVYN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 TRINITY OAKS BLVD STE 125
TRINITY FL
34655-4405
US

IV. Provider business mailing address

2044 TRINITY OAKS BLVD STE 125
TRINITY FL
34655-4405
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-0060
  • Fax: 866-551-6104
Mailing address:
  • Phone: 727-376-0060
  • Fax: 866-551-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS21139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: