Healthcare Provider Details

I. General information

NPI: 1164368940
Provider Name (Legal Business Name): NATALYA KONONENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8428 LILY LN
LAUREL MD
20723-1069
US

IV. Provider business mailing address

8428 LILY LN
LAUREL MD
20723-1069
US

V. Phone/Fax

Practice location:
  • Phone: 240-709-9279
  • Fax:
Mailing address:
  • Phone: 240-709-9279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: