Provider Demographics
NPI:1699319459
Name:VOLOSYANKO, ROMANNA
Entity type:Individual
Prefix:
First Name:ROMANNA
Middle Name:
Last Name:VOLOSYANKO
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 1:2030 81ST ST APT 2FT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1807
Mailing Address - Country:US
Mailing Address - Phone:646-508-0413
Mailing Address - Fax:
Practice Address - Street 1:482 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4708
Practice Address - Country:US
Practice Address - Phone:718-879-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty