Healthcare Provider Details

I. General information

NPI: 1053781740
Provider Name (Legal Business Name): ANNA SINYAVSKAYA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 65TH ST
BROOKLYN NY
11204-4088
US

IV. Provider business mailing address

1706 AVENUE M 3RD FLOOR
BROOKLYN NY
11230-5307
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-3200
  • Fax:
Mailing address:
  • Phone: 347-828-2674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: