Individual
VSEVOLOD BAKIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
4 EMMA LN STE 402, CLIFTON PARK, NY 12065-3705
(518) 557-1712
(518) 557-1713
Mailing address
515 W MOUNTAIN RD, QUEENSBURY, NY 12804-8445
(917) 257-6053
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405894
NY
Other
Enumeration date
05/29/2024
Last updated
05/29/2024
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