Provider Demographics
NPI:1609532670
Name:SHMULYARENKO, ARTEM (RN)
Entity Type:Individual
Prefix:
First Name:ARTEM
Middle Name:
Last Name:SHMULYARENKO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HARRIS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1505
Mailing Address - Country:US
Mailing Address - Phone:718-844-1723
Mailing Address - Fax:
Practice Address - Street 1:85 HARRIS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1505
Practice Address - Country:US
Practice Address - Phone:718-844-1723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802000163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical