Provider Demographics
NPI:1104836279
Name:SHNAYDER, IGOR SHAMSHONOVICH (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:SHAMSHONOVICH
Last Name:SHNAYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-893-0640
Mailing Address - Fax:323-650-3337
Practice Address - Street 1:7737 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046
Practice Address - Country:US
Practice Address - Phone:323-893-0640
Practice Address - Fax:323-650-3337
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA761812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A761810Medicaid
A76181Medicare ID - Type Unspecified
H50790Medicare UPIN