Provider Demographics
NPI:1932274701
Name:SEREBRYANY, LYDMILA (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:LYDMILA
Middle Name:
Last Name:SEREBRYANY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 AVENUE P
Mailing Address - Street 2:APT #13
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6101
Mailing Address - Country:US
Mailing Address - Phone:718-232-3507
Mailing Address - Fax:
Practice Address - Street 1:80 AVENUE P
Practice Address - Street 2:APT #13
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6101
Practice Address - Country:US
Practice Address - Phone:718-232-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant