Provider Demographics
NPI:1063509081
Name:PYATIGORSKAYA, SVETLANA (FNP)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:PYATIGORSKAYA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SVETLANA
Other - Middle Name:
Other - Last Name:NERONOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1850 OCEAN PKWY APT E10
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3021
Mailing Address - Country:US
Mailing Address - Phone:917-589-5855
Mailing Address - Fax:
Practice Address - Street 1:1402 SHEEPSHEAD BAY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3814
Practice Address - Country:US
Practice Address - Phone:718-332-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334961363LF0000X
NJ26NJ01230100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily