Provider Demographics
NPI:1063032522
Name:BOLDYREV, OKSANA
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:BOLDYREV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2743
Mailing Address - Country:US
Mailing Address - Phone:347-614-7568
Mailing Address - Fax:
Practice Address - Street 1:282 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2743
Practice Address - Country:US
Practice Address - Phone:347-614-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily