Provider Demographics
NPI:1982257523
Name:SHAVULSKIY, MARIYA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIYA
Middle Name:
Last Name:SHAVULSKIY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COURT ST STE 808
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1108
Mailing Address - Country:US
Mailing Address - Phone:718-522-3600
Mailing Address - Fax:718-522-3667
Practice Address - Street 1:26 COURT ST STE 808
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1108
Practice Address - Country:US
Practice Address - Phone:718-522-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402584-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health