MEDICARE: SVETLANA KHANDROS M.D.,D.O.

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	207Q00000X	Family Medicine Physician	228243	NY

General Provider Information

NPI Number	:	1871578872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA KHANDROS M.D.,D.O.

Provider Business Mailing Address
First Line	:	2467 OCEAN AVE
Second Line	:	SUITE C
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3969
Country	:	US
Telephone Number	:	718-676-1768
Fax Number	:	718-676-1770

Provider Business Practice Location Address
First Line	:	2467 OCEAN AVE
Second Line	:	SUITE C
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3969
Country	:	US
Telephone Number	:	718-676-1768
Fax Number	:	718-676-1770

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	01/10/2011

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