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General NPI Number Information
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NPI Number | 1467712455
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Entity Type | Individual
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Provider Name | TATYANA N KUVSHINIKOV PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 3315 N RIDGE RD E STE 700A
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City | ASHTABULA
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State | OH
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Zip | 44004-4300
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Country | US
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Telephone | 440-484-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 814 KEEFUS RD
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City | CONNEAUT
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State | OH
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Zip | 44030-9784
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Country | US
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Telephone | 814-860-6416
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA055473
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.006454RX
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA002842
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License Number State | PA
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