Provider Demographics
NPI:1023837655
Name:VIAROUKA, ANASTASIYA (CRNP)
Entity type:Individual
Prefix:
First Name:ANASTASIYA
Middle Name:
Last Name:VIAROUKA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 S BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-1218
Mailing Address - Country:US
Mailing Address - Phone:267-255-4871
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 350
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3238
Practice Address - Country:US
Practice Address - Phone:610-527-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030898207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease