MEDICARE: SVETLANA BANDUKA

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1518769520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA BANDUKA

Provider Business Mailing Address
First Line	:	6355 S DURANGO DR UNIT 1192
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1870
Country	:	US
Telephone Number	:	503-754-0470
Fax Number	:	503-754-0470

Provider Business Practice Location Address
First Line	:	6355 S DURANGO DR UNIT 1192
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1870
Country	:	US
Telephone Number	:	503-754-0470
Fax Number	:	503-754-0470

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

Provider Enumeration Date	:	03/27/2025
Last Update Date	:	03/27/2025

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Directions to “ SVETLANA BANDUKA ” Practice Location

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