Halyna Petsukh, AGNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

310163 Issued in NY

Practice address

2758 Ocean Ave Apt 5C
Brooklyn, NY 11229-4761

Phone

(347) 605-9794

NPI assigned

Mar 11, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1831774801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2758 OCEAN AVE APT 5C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112294761",
            "telephone_number": "347-605-9794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2758 OCEAN AVE APT 5C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112294761",
            "telephone_number": "347-605-9794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETSUKH",
        "first_name": "HALYNA",
        "credential": "AGNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "310163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Petrychenko Physician PC
• Dmitri Petrychenko, M.D.
• Kateryna Petrychenko
• Liliya Petrychuk
• Elaine A Petses, RPH,CDM
• Carla Luisa Petterkin-Caldwell, MD
• Cristina Rose Petti
• Glenda Pettiford, MSPED
• Bobbie Bruce Pettigrew Jr.
• Stephanie Soraya Pettigrew

• Adult Health Nurse Practitioner in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.