Provider Demographics
NPI:1013297118
Name:SHTEIN, LYUDMILA (DO)
Entity type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:SHTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYUDMILA
Other - Middle Name:
Other - Last Name:TKACHENKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:352 52ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1810
Mailing Address - Country:US
Mailing Address - Phone:718-684-1760
Mailing Address - Fax:718-684-1757
Practice Address - Street 1:1068 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2303
Practice Address - Country:US
Practice Address - Phone:718-684-1760
Practice Address - Fax:718-684-1757
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine