Healthcare Provider Details

I. General information

NPI: 1609660661
Provider Name (Legal Business Name): FEEDING THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 SAINT ROSE PKWY STE 110
HENDERSON NV
89052-4842
US

IV. Provider business mailing address

9630 ORCHID BAY DR
LAS VEGAS NV
89123-3962
US

V. Phone/Fax

Practice location:
  • Phone: 800-966-0535
  • Fax: 800-966-1135
Mailing address:
  • Phone: 917-301-2278
  • Fax: 917-301-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SVETLANA FEDYUSHKINA
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 917-301-2278