Provider Demographics
NPI:1114242039
Name:KOVALYSHYN, IVANKA (DO)
Entity type:Individual
Prefix:DR
First Name:IVANKA
Middle Name:
Last Name:KOVALYSHYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 EXCHANGE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4450
Mailing Address - Country:US
Mailing Address - Phone:561-247-4984
Mailing Address - Fax:561-431-2821
Practice Address - Street 1:4700 EXCHANGE CT STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4450
Practice Address - Country:US
Practice Address - Phone:561-247-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011030207ND0900X
FLOS13270207ND0900X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program