Provider Demographics
NPI:1841459286
Name:SHNAYDER, LYUDMILA V (DMD)
Entity type:Individual
Prefix:DR
First Name:LYUDMILA
Middle Name:V
Last Name:SHNAYDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5722
Mailing Address - Country:US
Mailing Address - Phone:617-387-2233
Mailing Address - Fax:617-389-2233
Practice Address - Street 1:95 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5722
Practice Address - Country:US
Practice Address - Phone:617-387-2233
Practice Address - Fax:617-389-2233
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0204510Medicaid