Organization
ADVANCED ENT AND ALLERGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATIANA SYCHEVA-JOHNSON (CHRO)
(404) 545-5166
Entity
Organization
Contact information
Practice address
2944 BRECKENRIDGE LN, LOUISVILLE, KY 40220-1409
(502) 893-0159
(502) 213-3893
Mailing address
2944 BRECKENRIDGE LN, LOUISVILLE, KY 40220-1409
(502) 893-0159
(502) 213-3843
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
2085R0001X
Radiation Oncology Physician
—
—
225100000X
Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
231H00000X
Audiologist
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200981820
—
IN
05
—
7100102680
—
KY
Enumeration date
08/27/2009
Last updated
12/16/2024
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