Provider Demographics
NPI:1518449198
Name:SEVASTYANOVA, NATALIYA (CNP)
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:SEVASTYANOVA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2219
Mailing Address - Country:US
Mailing Address - Phone:413-214-1899
Mailing Address - Fax:
Practice Address - Street 1:1049 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-0110
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-731-9919
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT145419163W00000X
MARN2266550363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily