Healthcare Provider Details

I. General information

NPI: 1093640740
Provider Name (Legal Business Name): IRYNA TOMAIEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

12133 SWEET BRIAR RD
PHILADELPHIA PA
19154-1713
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-2900
  • Fax:
Mailing address:
  • Phone: 267-306-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: