Provider Demographics
NPI:1013444116
Name:SHAMAILOV, MAYA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:SHAMAILOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:BENIAMINOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, PCCN
Mailing Address - Street 1:1680 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2713
Mailing Address - Country:US
Mailing Address - Phone:216-501-1430
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist