Healthcare Provider Details

I. General information

NPI: 1902425127
Provider Name (Legal Business Name): ANASTASIYA GUZCHENKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2937 AVENUE V
BROOKLYN NY
11229-5247
US

IV. Provider business mailing address

2937 AVENUE V
BROOKLYN NY
11229-5247
US

V. Phone/Fax

Practice location:
  • Phone: 551-214-1858
  • Fax:
Mailing address:
  • Phone: 551-214-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number062112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: