=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942780390
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALLIA KLESHCHANKA FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2018
-----------------------------------------------------
Last Update Date | 01/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 VICTORY BLVD
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-6792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-672-0805
-----------------------------------------------------
Fax | 347-745-7019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 345 DEWEY AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10308-1504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-672-0805
-----------------------------------------------------
Fax | 347-745-7019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 343509
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------