Provider Demographics
NPI:1316326515
Name:ALEKSEYENKO, ALEKSEY
Entity type:Individual
Prefix:
First Name:ALEKSEY
Middle Name:
Last Name:ALEKSEYENKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MHPG PRIMARY CARE @ TRADITION HEALTH PARK II
Mailing Address - Street 2:10080 SW INNOVATION WAY SUITE 201
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987
Mailing Address - Country:US
Mailing Address - Phone:772-344-3811
Mailing Address - Fax:772-344-3890
Practice Address - Street 1:MHPG PRIMARY CARE @ TRADITION HEALTH PARK II
Practice Address - Street 2:10080 SW INNOVATION WAY SUITE 201
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987
Practice Address - Country:US
Practice Address - Phone:772-344-3811
Practice Address - Fax:772-344-3890
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS15148207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine