Provider Demographics
NPI:1669269262
Name:DOTSENKO, ROSTISLAV
Entity type:Individual
Prefix:
First Name:ROSTISLAV
Middle Name:
Last Name:DOTSENKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 TAFT ST APT 838
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3244
Mailing Address - Country:US
Mailing Address - Phone:747-256-9687
Mailing Address - Fax:747-256-9687
Practice Address - Street 1:1600 TAFT ST APT 838
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3244
Practice Address - Country:US
Practice Address - Phone:747-256-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL04918374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide