Provider Demographics
NPI:1306825567
Name:SVERKUNOVA, LYUDMILA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:SVERKUNOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3755
Mailing Address - Country:US
Mailing Address - Phone:718-645-0333
Mailing Address - Fax:718-645-3570
Practice Address - Street 1:3280 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3755
Practice Address - Country:US
Practice Address - Phone:718-645-0333
Practice Address - Fax:718-645-3570
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226506-012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514854Medicaid