Provider Demographics
NPI:1104682319
Name:FEDOTOVA, OKSANA (MS CF-SLP TSSLD BE)
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:FEDOTOVA
Suffix:
Gender:F
Credentials:MS CF-SLP TSSLD BE
Other - Prefix:
Other - First Name:OXANA
Other - Middle Name:
Other - Last Name:FEDOTOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2815 OCEAN PKWY APT 5G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7835
Mailing Address - Country:US
Mailing Address - Phone:718-490-5455
Mailing Address - Fax:
Practice Address - Street 1:2815 OCEAN PKWY APT 5G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7835
Practice Address - Country:US
Practice Address - Phone:718-490-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist