Provider Demographics
NPI:1750860490
Name:KHLYPNYCH, ANASTASIYA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANASTASIYA
Middle Name:
Last Name:KHLYPNYCH
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 1:111 S. 11TH STREET, GIBBONS BLDG SUITE 6210
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-955-6996
Mailing Address - Fax:215-955-6010
Practice Address - Street 1:111 S. 11TH STREET, SUITE 2170
Practice Address - Street 2:GIBBON BLDG SUITE 6210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-955-6996
Practice Address - Fax:215-955-6010
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059967363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical