Healthcare Provider Details

I. General information

NPI: 1548283427
Provider Name (Legal Business Name): LYNETTE SIERACKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 WEST OAKLAND PARK BLVD STE 203
LAUDERDALE LAKES FL
33313-1501
US

IV. Provider business mailing address

PO BOX 450186
SUNRISE FL
33345-0186
US

V. Phone/Fax

Practice location:
  • Phone: 954-733-5991
  • Fax: 954-733-5993
Mailing address:
  • Phone: 954-733-5991
  • Fax: 954-733-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME55272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: