Provider Demographics
NPI:1851806848
Name:SHCHEPIN, EGOR NIKOLAYEVICH
Entity Type:Individual
Prefix:
First Name:EGOR
Middle Name:NIKOLAYEVICH
Last Name:SHCHEPIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 PECK AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1422
Mailing Address - Country:US
Mailing Address - Phone:907-444-4831
Mailing Address - Fax:
Practice Address - Street 1:8130 PECK AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1422
Practice Address - Country:US
Practice Address - Phone:907-444-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRBT-17-44873OtherTRICARE