Healthcare Provider Details

I. General information

NPI: 1518338995
Provider Name (Legal Business Name): SVITLANA HRYHOROVA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 JUNCTION RD
MADISON WI
53717-2656
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8915
  • Fax: 608-265-5755
Mailing address:
  • Phone: 608-263-8915
  • Fax: 608-265-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3586-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: