Healthcare Provider Details

I. General information

NPI: 1740833375
Provider Name (Legal Business Name): ANASTASIYA B SKOROBOGATOVA WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 REISS PL APT 6K
BRONX NY
10467-8062
US

IV. Provider business mailing address

620 REISS PL APT 6K
BRONX NY
10467-8062
US

V. Phone/Fax

Practice location:
  • Phone: 917-573-7789
  • Fax:
Mailing address:
  • Phone: 917-573-7789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: