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General NPI Number Information
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NPI Number | 1740831833
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Entity Type | Individual
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Provider Name | DIANA ZAICHENKO MSAT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 190 E FLIGHT LINE RD BLDG 790
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City | LANGLEY AFB
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State | VA
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Zip | 23665-2204
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Country | US
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Telephone | 518-630-7759
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 EASTOVER CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8911
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Country | US
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Telephone | 518-630-7759
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126003021
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License Number State | VA
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