Provider Demographics
NPI:1366936247
Name:KALISH, SERENA LYNNE (PA-C, CLC)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:LYNNE
Last Name:KALISH
Suffix:
Gender:F
Credentials:PA-C, CLC
Other - Prefix:
Other - First Name:SERENA
Other - Middle Name:LYNNE
Other - Last Name:SCHWECHTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1121 UNIVERSITY BLVD W APT 503
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3318
Mailing Address - Country:US
Mailing Address - Phone:201-956-1363
Mailing Address - Fax:
Practice Address - Street 1:1121 UNIVERSITY BLVD W APT 503
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3318
Practice Address - Country:US
Practice Address - Phone:516-509-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPP-313868174N00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN