Provider Demographics
NPI:1891088415
Name:BYSHENKO, STANISLAV
Entity Type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:BYSHENKO
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 1:92 W CONNELLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1754
Mailing Address - Country:US
Mailing Address - Phone:724-347-5529
Mailing Address - Fax:
Practice Address - Street 1:92 W CONNELLY BLVD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-1754
Practice Address - Country:US
Practice Address - Phone:724-347-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine