Provider Demographics
NPI:1689401226
Name:MOLODYK, SVITLANA
Entity type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:MOLODYK
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 1:4466 COLDWATER CANYON AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-5022
Mailing Address - Country:US
Mailing Address - Phone:818-919-1448
Mailing Address - Fax:
Practice Address - Street 1:121 W LEXINGTON DR # L400C
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2230
Practice Address - Country:US
Practice Address - Phone:818-919-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
CARN95144163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163W00000XNursing Service ProvidersRegistered Nurse