Provider Demographics
NPI:1467853564
Name:SHINKEVICH, KSENIYA
Entity Type:Individual
Prefix:
First Name:KSENIYA
Middle Name:
Last Name:SHINKEVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 SHORE RD
Mailing Address - Street 2:APT 1J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 95TH ST
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7404
Practice Address - Country:US
Practice Address - Phone:718-680-9751
Practice Address - Fax:718-680-7977
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program