Healthcare Provider Details

I. General information

NPI: 1689386989
Provider Name (Legal Business Name): MARIA FEDYNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N OAKLEY BLVD APT 2W
CHICAGO IL
60622-3528
US

IV. Provider business mailing address

PO BOX 4832
BUFFALO GROVE IL
60089-4832
US

V. Phone/Fax

Practice location:
  • Phone: 847-722-3559
  • Fax:
Mailing address:
  • Phone: 847-722-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number238000288
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: