Provider Demographics
NPI:1447874342
Name:PRUDNIKAVA, ALESIA
Entity type:Individual
Prefix:MRS
First Name:ALESIA
Middle Name:
Last Name:PRUDNIKAVA
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 1:18201 COLLINS AVE APT 4707
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5153
Mailing Address - Country:US
Mailing Address - Phone:954-881-1523
Mailing Address - Fax:
Practice Address - Street 1:18201 COLLINS AVE APT 4707
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-5153
Practice Address - Country:US
Practice Address - Phone:954-881-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17278101YM0800X
MH17278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health