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General NPI Number Information
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NPI Number | 1114242039
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Entity Type | Individual
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Provider Name | IVANKA KOVALYSHYN D.O
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Gender | Female
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Dates
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Enumeration Date | 04/03/2010
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 4700 EXCHANGE CT STE 110
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City | BOCA RATON
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State | FL
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Zip | 33431-4450
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Country | US
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Telephone | 561-247-4984
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 EXCHANGE CT STE 110
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City | BOCA RATON
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State | FL
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Zip | 33431-4450
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Country | US
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Telephone | 561-247-4984
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Fax | 561-431-2821
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 34.011030
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | OS13270
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS13270
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License Number State | FL
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