Provider Demographics
NPI:1114083896
Name:SERGIYENKO, YELENA (AP)
Entity Type:Individual
Prefix:MS
First Name:YELENA
Middle Name:
Last Name:SERGIYENKO
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SW HOMELAND RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6285
Mailing Address - Country:US
Mailing Address - Phone:772-288-3668
Mailing Address - Fax:772-288-3655
Practice Address - Street 1:650 SW HOMELAND RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6285
Practice Address - Country:US
Practice Address - Phone:772-288-3668
Practice Address - Fax:772-288-3655
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist