Provider Demographics
NPI:1689045791
Name:ANISHCHENKO, ANASTASIA
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:ANISHCHENKO
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 1:1950 ADDISON ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1176
Mailing Address - Country:US
Mailing Address - Phone:510-548-9716
Mailing Address - Fax:
Practice Address - Street 1:1950 ADDISON ST
Practice Address - Street 2:SUITE 109
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1176
Practice Address - Country:US
Practice Address - Phone:510-548-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program