Healthcare Provider Details

I. General information

NPI: 1730615444
Provider Name (Legal Business Name): POLINA CHERPEL SRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS POLINA CHTCHERBAKOVA

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

26 ELISE TERRACE
TORONTO ONTARIO
M2R2X1
CA

V. Phone/Fax

Practice location:
  • Phone: 585-275-2141
  • Fax:
Mailing address:
  • Phone: 416-450-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number687755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: