Provider Demographics
NPI:1477108793
Name:TERESHCHENKO, ALEXANDER VLADIMIROVICH (MD, PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:VLADIMIROVICH
Last Name:TERESHCHENKO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 S BUR OAK PL STE 206
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2238
Mailing Address - Country:US
Mailing Address - Phone:605-743-0740
Mailing Address - Fax:
Practice Address - Street 1:5024 S BUR OAK PL STE 206
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2238
Practice Address - Country:US
Practice Address - Phone:605-743-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD155072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry