Provider Demographics
NPI:1295084986
Name:BREYCHER, SVETLANA
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:BREYCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FAWN LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6173
Mailing Address - Country:US
Mailing Address - Phone:718-351-2653
Mailing Address - Fax:
Practice Address - Street 1:40 FAWN LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-6173
Practice Address - Country:US
Practice Address - Phone:347-421-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY396548101174400000X
NY1248549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist