Provider Demographics
NPI:1518169648
Name:SHEMELYAK, IREN (LC AC)
Entity Type:Individual
Prefix:MRS
First Name:IREN
Middle Name:
Last Name:SHEMELYAK
Suffix:
Gender:F
Credentials:LC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2958 W 8TH ST
Mailing Address - Street 2:SUITE 20J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3223
Mailing Address - Country:US
Mailing Address - Phone:646-644-9780
Mailing Address - Fax:718-426-4240
Practice Address - Street 1:6127 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3542
Practice Address - Country:US
Practice Address - Phone:646-644-9780
Practice Address - Fax:718-426-4240
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001998320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities