Provider Demographics
NPI:1104214519
Name:SISHCHIUK, RADYSLAVA (NP)
Entity Type:Individual
Prefix:
First Name:RADYSLAVA
Middle Name:
Last Name:SISHCHIUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:SUITE 9V
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-0217
Mailing Address - Fax:212-263-2042
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 9V
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-0217
Practice Address - Fax:212-263-2042
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306555363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care