Provider Demographics
NPI:1730144809
Name:SHILIMOVA, YELENA (MD)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:SHILIMOVA
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 1:1009 BRIGHTON BEACH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5659
Mailing Address - Country:US
Mailing Address - Phone:718-975-8500
Mailing Address - Fax:718-975-8502
Practice Address - Street 1:1009 BRIGHTON BEACH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5659
Practice Address - Country:US
Practice Address - Phone:718-975-8500
Practice Address - Fax:718-975-8502
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204311207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867656Medicaid
NY204311OtherLICENSE NUMBER
NY36N071Medicare ID - Type Unspecified