Healthcare Provider Details

I. General information

NPI: 1891358255
Provider Name (Legal Business Name): IRINA CHERNYSHKOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 EASTERN BLVD
GLASTONBURY CT
06033-4325
US

IV. Provider business mailing address

406 BIRCH MOUNTAIN RD
GLASTONBURY CT
06033-1905
US

V. Phone/Fax

Practice location:
  • Phone: 860-328-8929
  • Fax: 860-935-8176
Mailing address:
  • Phone: 208-901-1640
  • Fax: 860-935-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number72335
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number72335
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: