Healthcare Provider Details

I. General information

NPI: 1649709940
Provider Name (Legal Business Name): YEVGENIYA SERGEYENKO MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 N YORK RD
WILLOW GROVE PA
19090-2150
US

IV. Provider business mailing address

91 N YORK RD
WILLOW GROVE PA
19090-2150
US

V. Phone/Fax

Practice location:
  • Phone: 215-951-8930
  • Fax: 215-659-1352
Mailing address:
  • Phone: 215-951-8930
  • Fax: 215-659-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD477130
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: