Individual
TATYANA KIRICHENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2705 MERMAID AVE, BROOKLYN, NY 11224-2005
(718) 265-2222
Mailing address
2730 E 28TH ST, BROOKLYN, NY 11235-2410
(347) 581-8118
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86051837
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86051837
LICENSE
NY
Enumeration date
11/02/2020
Last updated
11/02/2020
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