Provider Demographics
NPI:1871578872
Name:KHANDROS, SVETLANA (MD,DO)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:KHANDROS
Suffix:
Gender:F
Credentials:MD,DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2467 OCEAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3969
Mailing Address - Country:US
Mailing Address - Phone:718-676-1768
Mailing Address - Fax:718-676-1770
Practice Address - Street 1:2467 OCEAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3969
Practice Address - Country:US
Practice Address - Phone:718-676-1768
Practice Address - Fax:718-676-1770
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH91076Medicare UPIN