Provider Demographics
NPI:1932076304
Name:SHUDZEKA, SERGE
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:SHUDZEKA
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 1:9222 LIMESTONE PL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3944
Mailing Address - Country:US
Mailing Address - Phone:227-249-2193
Mailing Address - Fax:
Practice Address - Street 1:9222 LIMESTONE PL
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3944
Practice Address - Country:US
Practice Address - Phone:227-249-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200005571374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide