Provider Demographics
NPI:1891255477
Name:KRICHEVSKY, SVETLANA (MD)
Entity type:Individual
Prefix:DR
First Name:SVETLANA
Middle Name:
Last Name:KRICHEVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 945921
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5921
Mailing Address - Country:US
Mailing Address - Phone:201-745-2897
Mailing Address - Fax:386-586-4650
Practice Address - Street 1:60 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5980
Practice Address - Country:US
Practice Address - Phone:201-745-2897
Practice Address - Fax:386-586-4650
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153334207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine