Provider Demographics
NPI:1164559019
Name:SHEVCHENKO, TATYANA (PAC)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:SHEVCHENKO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BATTERY AVE
Mailing Address - Street 2:APT. 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3559
Mailing Address - Country:US
Mailing Address - Phone:718-921-9145
Mailing Address - Fax:212-423-8121
Practice Address - Street 1:1901 FIRST AVE RM 4B5
Practice Address - Street 2:DEPT. OB GYN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-423-6796
Practice Address - Fax:212-423-8121
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant