Provider Demographics
NPI:1962042655
Name:SHIFMAN, TATYANA (MSSPED)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:SHIFMAN
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 E 5TH ST APT 26
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5812
Mailing Address - Country:US
Mailing Address - Phone:917-362-8444
Mailing Address - Fax:
Practice Address - Street 1:669 E 5TH ST APT 26
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5812
Practice Address - Country:US
Practice Address - Phone:917-362-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty