Provider Demographics
NPI:1619369097
Name:SILENKO, ALEKSEY
Entity Type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:SILENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 UNIVERSITY AVE SE
Mailing Address - Street 2:#25
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1778
Mailing Address - Country:US
Mailing Address - Phone:952-486-0336
Mailing Address - Fax:
Practice Address - Street 1:505 UNIVERSITY AVE SE
Practice Address - Street 2:APT 205
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1778
Practice Address - Country:US
Practice Address - Phone:952-486-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1840829172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver