MEDICARE: OLESYA GAVRYLYUK

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F401901-1	NY

General Provider Information

NPI Number	:	1235598111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLESYA GAVRYLYUK

Provider Business Mailing Address
First Line	:	160 WATER ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-5037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 WATER ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-5037
Country	:	US
Telephone Number	:	646-458-2810
Fax Number	:

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

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	02/19/2016

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