Provider Demographics
NPI:1407046543
Name:SHAYEVITZ, MYRA B (MD)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:B
Last Name:SHAYEVITZ
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 1:4897 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1323
Mailing Address - Country:US
Mailing Address - Phone:315-423-5039
Mailing Address - Fax:
Practice Address - Street 1:518 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2238
Practice Address - Country:US
Practice Address - Phone:315-423-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26725207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine