MEDICARE: MARINA BYSHOVETS

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	383190	NY

General Provider Information

NPI Number	:	1952909012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA BYSHOVETS

Provider Business Mailing Address
First Line	:	164 ADMIRALTY LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3964
Country	:	US
Telephone Number	:	347-902-9375
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 ADMIRALTY LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3964
Country	:	US
Telephone Number	:	347-902-9375
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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Directions to “ MARINA BYSHOVETS ” Practice Location

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