Healthcare Provider Details

I. General information

NPI: 1851213391
Provider Name (Legal Business Name): VICTORIA DEMYDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 VOORHIES AVE APT 5M
BROOKLYN NY
11235-2617
US

IV. Provider business mailing address

2330 VOORHIES AVE APT 5M
BROOKLYN NY
11235-2617
US

V. Phone/Fax

Practice location:
  • Phone: 347-229-5549
  • Fax:
Mailing address:
  • Phone: 347-229-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102043-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: