Sergey M Kondrashov

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SZ9514 Issued in FL

Practice address

427 Burns Ave
Lake Wales, FL 33853-3314

Phone

(863) 679-3338

NPI assigned

Aug 13, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Serguei M Kondrachov Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Victory Ridge Academy, Inc.

  • Clinic/Center
  • Lake Wales, FL
  • NPI 1184044612

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1760093678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6548 TIMBER SHORES RD",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338989061",
            "telephone_number": "337-442-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 BURNS AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338533314",
            "telephone_number": "863-679-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONDRASHOV",
        "first_name": "SERGEY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ9514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SERGUEI",
            "last_name": "KONDRACHOV",
            "middle_name": "M",
            "prefix": "MR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan Bradford King, DMD
• Felicia Knighton, HHA
• Raymond R Knisley, DO
• Elizabeth Michele Koelsch, MA, CCC-SLP
• Joseph Patrick Koloc, MSPT
• Kris Fitzgerald, LMHC, PLLC
• L & E Express Transport, Inc
• L & E Helping Hands LLC
• Salim Lahlou, M.D.
• Lake Wale Pediatric Internal Medicine P.a.

• Speech-Language Pathologist in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.