Provider Demographics
NPI:1114069259
Name:LISOVSKIY, SVETLANA ALEXANDER (PA)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:ALEXANDER
Last Name:LISOVSKIY
Suffix:
Gender:
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3944 RANCH ROAD 620 S STE 100
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7000
Mailing Address - Country:US
Mailing Address - Phone:512-580-5775
Mailing Address - Fax:
Practice Address - Street 1:3944 RANCH ROAD 620 S STE 100
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7000
Practice Address - Country:US
Practice Address - Phone:512-580-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical