Provider Demographics
NPI:1619842234
Name:SOSUNOVA, YELIZAVETA
Entity type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:
Last Name:SOSUNOVA
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 1:1685 OCEAN AVE APT 1I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5428
Mailing Address - Country:US
Mailing Address - Phone:929-489-6642
Mailing Address - Fax:
Practice Address - Street 1:1685 OCEAN AVE APT 1I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5428
Practice Address - Country:US
Practice Address - Phone:929-489-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty