Provider Demographics
NPI:1376913509
Name:SEREDYNSKI, ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SEREDYNSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E SUPERIOR ST
Mailing Address - Street 2:STE 306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2595
Mailing Address - Country:US
Mailing Address - Phone:312-754-9404
Mailing Address - Fax:312-754-9402
Practice Address - Street 1:1 E SUPERIOR ST
Practice Address - Street 2:STE. 306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2507
Practice Address - Country:US
Practice Address - Phone:312-754-9404
Practice Address - Fax:312-754-9402
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant