Provider Demographics
NPI:1346404118
Name:NESTERENKO, MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:NESTERENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYNA
Other - Middle Name:
Other - Last Name:RUDZYNSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5682 BEE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1540
Mailing Address - Country:US
Mailing Address - Phone:941-371-3349
Mailing Address - Fax:
Practice Address - Street 1:5682 BEE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1540
Practice Address - Country:US
Practice Address - Phone:941-371-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2592202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400060421Medicare PIN
NY03432524Medicaid