Provider Demographics
NPI:1417841909
Name:ANDREYEFF, SERGE
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:ANDREYEFF
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 MINKS POND RD
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-7623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1309 COFFEEN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5777
Practice Address - Country:US
Practice Address - Phone:201-388-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF355947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner