Healthcare Provider Details

I. General information

NPI: 1922096494
Provider Name (Legal Business Name): AUDREY ANN SERNYAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY HERNANDEZ RAPP

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 OMEGA DR BLDG B-86
NEWARK DE
19713-2065
US

IV. Provider business mailing address

86 OMEGA DR BLDG B-86
NEWARK DE
19713-2065
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-1929
  • Fax: 302-368-7943
Mailing address:
  • Phone: 302-421-4828
  • Fax: 302-421-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA08250300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberK1289
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC1-0010530
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: