Healthcare Provider Details

I. General information

NPI: 1770558454
Provider Name (Legal Business Name): ALEX SENCHENKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 S TAMIAMI TRAIL, FLOOR 3
SARASOTA FL
34239
US

IV. Provider business mailing address

PO BOX 3612
SARASOTA FL
34230
US

V. Phone/Fax

Practice location:
  • Phone: 507-398-2753
  • Fax: 941-866-9024
Mailing address:
  • Phone: 507-398-2753
  • Fax: 941-866-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME130013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME130013
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number77201
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME130013
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME130013
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME130013
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number77201
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME130013
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME130013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: