MEDICARE: MYKYTA LYASHENKO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134061302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYKYTA LYASHENKO DO

Provider Business Mailing Address
First Line	:	2421 BRENTWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-3307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 BRENTWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-3307
Country	:	US
Telephone Number	:	281-665-0554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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