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General NPI Number Information
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NPI Number | 1083290423
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Entity Type | Individual
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Provider Name | IVANNA TSYKHULYAK APRN
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Gender | Female
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 2247 E MAIN ST STE 103
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City | WATERBURY
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State | CT
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Zip | 06705-2604
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Country | US
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Telephone | 203-527-7269
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Fax |
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Provider Business Mailing Address
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Address Line | 129 OAKRIDGE
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City | UNIONVILLE
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State | CT
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Zip | 06085-1475
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Country | US
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Telephone | 347-583-5429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 9584
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License Number State | CT
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