Provider Demographics
NPI:1053792515
Name:FAMINA, SVETLANA (MD)
Entity type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:FAMINA
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 1:1530 LONE OAK RD STE 345
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD STE 345
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7942
Practice Address - Country:US
Practice Address - Phone:270-444-2250
Practice Address - Fax:270-538-6596
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2022-12-19
Deactivation Date:2016-01-20
Deactivation Code:
Reactivation Date:2017-08-24
Provider Licenses
StateLicense IDTaxonomies
KYR37672084P0800X
KY518612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry