MEDICARE: VIKTOR SHALYPIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN2345809	MA

General Provider Information

NPI Number	:	1164383642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKTOR SHALYPIN NP

Provider Business Mailing Address
First Line	:	15 RIDGECREST CIR
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-4525
Country	:	US
Telephone Number	:	413-777-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 ASHLEY AVE
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-1302
Country	:	US
Telephone Number	:	413-693-2852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	12/17/2025

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