Provider Demographics
NPI:1578974473
Name:SHEVCHENKO, DMITRY (OTR/L)
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:SHEVCHENKO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:DMITRY
Other - Middle Name:
Other - Last Name:SHEVCHENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3030 EMMONS AVE APT 5T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2228
Mailing Address - Country:US
Mailing Address - Phone:347-766-9077
Mailing Address - Fax:
Practice Address - Street 1:3030 EMMONS AVE APT 5T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:347-766-9077
Practice Address - Fax:800-969-0292
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018851-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist