Healthcare Provider Details

I. General information

NPI: 1275833238
Provider Name (Legal Business Name): FRACTEL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 PANTONBURY ST
NEW ALBANY OH
43054-9051
US

IV. Provider business mailing address

4402 PANTONBURY ST
NEW ALBANY OH
43054-9051
US

V. Phone/Fax

Practice location:
  • Phone: 614-205-0295
  • Fax: 730-731-0414
Mailing address:
  • Phone: 614-205-0295
  • Fax: 730-731-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name: OKSANA C SHNAYDER
Title or Position: PRESIDENT
Credential: CST/CFA
Phone: 614-205-0295