Provider Demographics
NPI:1588109714
Name:FIELDS, SVETLANA (LMBT)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 NEILL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2000
Mailing Address - Country:US
Mailing Address - Phone:980-309-4866
Mailing Address - Fax:
Practice Address - Street 1:2233 MATTHEWS TOWNSHIP PKWY STE H-1
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4821
Practice Address - Country:US
Practice Address - Phone:704-846-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-26
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist