Provider Demographics
NPI:1649709940
Name:SERGEYENKO, YEVGENIYA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:YEVGENIYA
Middle Name:
Last Name:SERGEYENKO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W TABOR RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3099
Mailing Address - Country:US
Mailing Address - Phone:215-456-9850
Mailing Address - Fax:
Practice Address - Street 1:1200 W TABOR RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3099
Practice Address - Country:US
Practice Address - Phone:215-456-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD477130208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation