Provider Demographics
NPI:1679273221
Name:SVIRSKY, EGOR ANDREEVICH
Entity Type:Individual
Prefix:
First Name:EGOR
Middle Name:ANDREEVICH
Last Name:SVIRSKY
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 1:1164 LA ROCHELLE TER UNIT D
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-1797
Mailing Address - Country:US
Mailing Address - Phone:408-373-5795
Mailing Address - Fax:
Practice Address - Street 1:1164 LA ROCHELLE TER UNIT D
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-1797
Practice Address - Country:US
Practice Address - Phone:408-373-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician