Provider Demographics
NPI:1609181270
Name:SHESTAKOVA, NATALYA (LPN)
Entity Type:Individual
Prefix:
First Name:NATALYA
Middle Name:
Last Name:SHESTAKOVA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 MAPLEWOOD RD
Mailing Address - Street 2:G 203
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1848
Mailing Address - Country:US
Mailing Address - Phone:330-881-5553
Mailing Address - Fax:
Practice Address - Street 1:6312 MAPLEWOOD RD
Practice Address - Street 2:G 203
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-1848
Practice Address - Country:US
Practice Address - Phone:330-881-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126892 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse