Provider Demographics
NPI:1194187542
Name:NEVELEV, SHANNA (MD)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:NEVELEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:KOFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3411 WAYNE AVE FL 8
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2552
Mailing Address - Country:US
Mailing Address - Phone:718-741-2507
Mailing Address - Fax:
Practice Address - Street 1:3411 WAYNE AVE FL 8
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2552
Practice Address - Country:US
Practice Address - Phone:718-741-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics