Provider Demographics
NPI:1669438941
Name:SHURP, YEVGENIYA (MD)
Entity Type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:SHURP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 N BEDFORD RD STE 6
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1149
Mailing Address - Country:US
Mailing Address - Phone:212-226-7666
Mailing Address - Fax:
Practice Address - Street 1:4 MORRISEY DRIVE
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579
Practice Address - Country:US
Practice Address - Phone:845-528-5222
Practice Address - Fax:845-528-8589
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207317208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01809961Medicaid
NY01809961Medicaid