Healthcare Provider Details

I. General information

NPI: 1891255477
Provider Name (Legal Business Name): SVETLANA KRICHEVSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MEMORIAL MEDICAL PKWY
PALM COAST FL
32164-5980
US

IV. Provider business mailing address

PO BOX 945921
ATLANTA GA
30394-5921
US

V. Phone/Fax

Practice location:
  • Phone: 201-745-2897
  • Fax: 386-586-4650
Mailing address:
  • Phone: 201-745-2897
  • Fax: 386-586-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME153334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: