Healthcare Provider Details

I. General information

NPI: 1093399578
Provider Name (Legal Business Name): VALERIYA SEMENOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 26TH ST
NEW YORK NY
10001-6975
US

IV. Provider business mailing address

160 W 26TH ST
NEW YORK NY
10001-6975
US

V. Phone/Fax

Practice location:
  • Phone: 646-660-9999
  • Fax:
Mailing address:
  • Phone: 646-660-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: