Provider Demographics
NPI:1518947894
Name:SHIRIAEVA, NATALIA ANATOLIEVNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:ANATOLIEVNA
Last Name:SHIRIAEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-4511
Mailing Address - Country:US
Mailing Address - Phone:904-964-1888
Mailing Address - Fax:904-964-1884
Practice Address - Street 1:1546 S WATER ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-4511
Practice Address - Country:US
Practice Address - Phone:904-964-1888
Practice Address - Fax:904-964-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58602OtherBCBS PROVIDER ID
FLG92831Medicare UPIN
FLE2513ZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID