MEDICARE: OXANA Z PETRUNICHEVA

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	106S00000X	Behavior Technician		NY
2	222Q00000X	Developmental Therapist		NY

General Provider Information

NPI Number	:	1588594840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OXANA Z PETRUNICHEVA

Provider Business Mailing Address
First Line	:	3033 BRIGHTON 14TH ST APT B1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5571
Country	:	US
Telephone Number	:	347-377-1213
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 BRIGHTON 14TH ST APT B1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5571
Country	:	US
Telephone Number	:	347-377-1213
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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Directions to “ OXANA Z PETRUNICHEVA ” Practice Location

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