Provider Demographics
NPI:1922383017
Name:VASSILEVA, ELISSAVETA DIMITROVA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELISSAVETA
Middle Name:DIMITROVA
Last Name:VASSILEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 W SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215
Mailing Address - Country:US
Mailing Address - Phone:315-435-5511
Mailing Address - Fax:315-435-5520
Practice Address - Street 1:5075 W SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-435-5511
Practice Address - Fax:315-435-5520
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334157-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily