Provider Demographics
NPI:1619242336
Name:SHTYRYOVA, TETYANA G (RN)
Entity Type:Individual
Prefix:MS
First Name:TETYANA
Middle Name:G
Last Name:SHTYRYOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 BRIGHTON 7TH ST
Mailing Address - Street 2:APT 5I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6565
Mailing Address - Country:US
Mailing Address - Phone:718-648-4350
Mailing Address - Fax:
Practice Address - Street 1:3133 BRIGHTON 7TH ST
Practice Address - Street 2:APT 5I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6565
Practice Address - Country:US
Practice Address - Phone:718-648-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647127163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse