Healthcare Provider Details

I. General information

NPI: 1568770089
Provider Name (Legal Business Name): LYNETTE SIERACKI, DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W OAKLAND PARK BLVD SUITE 203
LAUDERDALE LAKES FL
33313-7500
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: DR. LYNETTE SIERACKI
Title or Position: PHYSICIAN OWNER
Credential: D.O.
Phone: 954-733-5991