Provider Demographics
NPI:1396301396
Name:SMOLEN, IRYNA (PA-C)
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:SMOLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IRYNA
Other - Middle Name:
Other - Last Name:USTYANOVSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33114
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-0114
Mailing Address - Country:US
Mailing Address - Phone:216-258-6355
Mailing Address - Fax:
Practice Address - Street 1:26900 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1191
Practice Address - Country:US
Practice Address - Phone:216-839-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005905RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant