Provider Demographics
NPI:1609446822
Name:RAICHIK, SHIFRAH (MS)
Entity Type:Individual
Prefix:
First Name:SHIFRAH
Middle Name:
Last Name:RAICHIK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 EASTERN PKWY APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3465
Mailing Address - Country:US
Mailing Address - Phone:323-273-3617
Mailing Address - Fax:
Practice Address - Street 1:709 EASTERN PKWY APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3465
Practice Address - Country:US
Practice Address - Phone:323-273-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty