Provider Demographics
NPI:1972613768
Name:SHAMAEV BERK, YANA (MD)
Entity Type:Individual
Prefix:DR
First Name:YANA
Middle Name:
Last Name:SHAMAEV BERK
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 1:200 WEST CARVER STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:347-389-4945
Mailing Address - Fax:631-421-5991
Practice Address - Street 1:200 WEST CARVER STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:347-389-4945
Practice Address - Fax:631-421-5991
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192338-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
192338OtherSTATE LICENSE #
112234982OtherAETNA
192338OtherHIP
192338OtherMEDICAL LICENSE NUMBER
P3654049OtherOXFORD
2417161OtherUNITED
P0041416OtherRAILROAD MEDICARE
112234962OtherTAX ID
2146968OtherVYTRA