Provider Demographics
NPI:1376286534
Name:PEYSAKHOVICH, SOFYA (DO)
Entity Type:Individual
Prefix:
First Name:SOFYA
Middle Name:
Last Name:PEYSAKHOVICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SOFYA
Other - Middle Name:PEYSAKHOVICH
Other - Last Name:DROSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:229 S MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5725
Mailing Address - Country:US
Mailing Address - Phone:920-832-2783
Mailing Address - Fax:
Practice Address - Street 1:229 S MORRISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5725
Practice Address - Country:US
Practice Address - Phone:920-832-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program