Healthcare Provider Details

I. General information

NPI: 1588594840
Provider Name (Legal Business Name): OXANA Z PETRUNICHEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 BRIGHTON 14TH ST APT B1
BROOKLYN NY
11235-5571
US

IV. Provider business mailing address

3033 BRIGHTON 14TH ST APT B1
BROOKLYN NY
11235-5571
US

V. Phone/Fax

Practice location:
  • Phone: 347-377-1213
  • Fax:
Mailing address:
  • Phone: 347-377-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: