Provider Demographics
NPI:1548637945
Name:MALYUK, INNA OKSANA (BA)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:OKSANA
Last Name:MALYUK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E OFFICE ST
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-1606
Mailing Address - Country:US
Mailing Address - Phone:502-229-9196
Mailing Address - Fax:
Practice Address - Street 1:124 E OFFICE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1606
Practice Address - Country:US
Practice Address - Phone:502-229-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid