Healthcare Provider Details

I. General information

NPI: 1053205807
Provider Name (Legal Business Name): NATALIYA SANNIKOVA NHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 BROADWAY # 1440
NEW YORK NY
10024-5805
US

IV. Provider business mailing address

511 68TH ST APT 1B
BROOKLYN NY
11220-6005
US

V. Phone/Fax

Practice location:
  • Phone: 608-291-9820
  • Fax:
Mailing address:
  • Phone: 347-641-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP136294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: