Provider Demographics
NPI:1922862218
Name:SHEVCHUK, TETYANA
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:SHEVCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12781 W SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1052
Mailing Address - Country:US
Mailing Address - Phone:440-533-5383
Mailing Address - Fax:
Practice Address - Street 1:2935 LINCOLN WAY NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5203
Practice Address - Country:US
Practice Address - Phone:330-236-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily