Provider Demographics
NPI:1891333936
Name:KHRISHCHANOVICH, LYUBAVA (PA-C)
Entity Type:Individual
Prefix:
First Name:LYUBAVA
Middle Name:
Last Name:KHRISHCHANOVICH
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 1:2109 85TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3221
Mailing Address - Country:US
Mailing Address - Phone:347-907-2592
Mailing Address - Fax:
Practice Address - Street 1:2109 85TH ST APT 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3221
Practice Address - Country:US
Practice Address - Phone:718-644-8156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program