Provider Demographics
NPI:1588432454
Name:MUKBANIANI, SVETLANA
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:MUKBANIANI
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 1:1608 OCEAN PKWY APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7021
Mailing Address - Country:US
Mailing Address - Phone:646-546-7875
Mailing Address - Fax:
Practice Address - Street 1:5 W 86TH ST APT 9C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3664
Practice Address - Country:US
Practice Address - Phone:646-389-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program