MEDICARE: IRINA SVISTUNOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1194360727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA SVISTUNOVA

Provider Business Mailing Address
First Line	:	2935 W 5TH ST APT 16G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3925
Country	:	US
Telephone Number	:	347-556-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	2935 W 5TH ST APT 16G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3925
Country	:	US
Telephone Number	:	347-556-6819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “ IRINA SVISTUNOVA ” Practice Location

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