MEDICARE: DMITRY SHINDELMAN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	381653	NY

General Provider Information

NPI Number	:	1952793747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DMITRY SHINDELMAN CPNP

Provider Business Mailing Address
First Line	:	300 CHELSEA ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1715
Country	:	US
Telephone Number	:	646-465-3055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4127
Country	:	US
Telephone Number	:	646-465-3055
Fax Number	:	718-338-0704

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

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	09/24/2021

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