Provider Demographics
NPI:1346911732
Name:SHIMONOV, YURI MIKHAIL (NP)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:MIKHAIL
Last Name:SHIMONOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9831 65TH RD APT 3E
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3515
Mailing Address - Country:US
Mailing Address - Phone:347-653-4872
Mailing Address - Fax:
Practice Address - Street 1:9831 65TH RD APT 3E
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3515
Practice Address - Country:US
Practice Address - Phone:347-653-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310335363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health