Provider Demographics
NPI:1003216821
Name:SHIMANOVSKY, LUDMILA (MD)
Entity Type:Individual
Prefix:
First Name:LUDMILA
Middle Name:
Last Name:SHIMANOVSKY
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 1:1157 JONAH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-9496
Mailing Address - Country:US
Mailing Address - Phone:941-999-0080
Mailing Address - Fax:
Practice Address - Street 1:1157 JONAH DR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9496
Practice Address - Country:US
Practice Address - Phone:941-999-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118133261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care