Provider Demographics
NPI:1780118679
Name:SHAYDAKOV, MAXIM (MD)
Entity type:Individual
Prefix:
First Name:MAXIM
Middle Name:
Last Name:SHAYDAKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVENUE
Mailing Address - Street 2:FORBES TOWER-PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:989-746-7500
Mailing Address - Fax:989-583-6955
Practice Address - Street 1:200 LOTHROP STREET
Practice Address - Street 2:UPMC PRESBYTERIAN HOSPITAL ROOM E3624
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2582
Practice Address - Country:US
Practice Address - Phone:412-802-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
MI4301116183208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program