Provider Demographics
NPI:1972758449
Name:SHIYAN, IRINA (OD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:SHIYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2527
Mailing Address - Country:US
Mailing Address - Phone:917-880-7195
Mailing Address - Fax:
Practice Address - Street 1:170 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5793
Practice Address - Country:US
Practice Address - Phone:212-600-9279
Practice Address - Fax:646-582-1429
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT007372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVUT007372OtherNYS LICENSE NUMBER