Provider Demographics
NPI:1437511789
Name:BERESHNYY, ANDRIY
Entity Type:Individual
Prefix:
First Name:ANDRIY
Middle Name:
Last Name:BERESHNYY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5616
Mailing Address - Country:US
Mailing Address - Phone:262-548-1400
Mailing Address - Fax:
Practice Address - Street 1:1810 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5616
Practice Address - Country:US
Practice Address - Phone:262-548-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility