MEDICARE: NINA SHAMAYEVA RPH

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	183500000X	Pharmacist	5380710001	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3342401	OTHER	NY	NABP

General Provider Information

NPI Number	:	1295800027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA SHAMAYEVA RPH

Provider Business Mailing Address
First Line	:	6701 AUSTIN ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 AUSTIN ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3533
Country	:	US
Telephone Number	:	718-459-0090
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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