Healthcare Provider Details

I. General information

NPI: 1255017497
Provider Name (Legal Business Name): MS. NATALIE NELSON DYSENCHUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WESTCHESTER AVE
WHITE PLAINS NY
10604-3516
US

IV. Provider business mailing address

1133 WESTCHESTER AVE
WHITE PLAINS NY
10604-3516
US

V. Phone/Fax

Practice location:
  • Phone: 914-643-1542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: