Provider Demographics
NPI:1689914467
Name:SHAIN, VIKTORIYA (SC)
Entity Type:Individual
Prefix:MS
First Name:VIKTORIYA
Middle Name:
Last Name:SHAIN
Suffix:
Gender:F
Credentials:SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 DAHILL RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3537
Mailing Address - Country:US
Mailing Address - Phone:347-634-1111
Mailing Address - Fax:
Practice Address - Street 1:1580 DAHILL RD FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3537
Practice Address - Country:US
Practice Address - Phone:347-634-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator