Healthcare Provider Details

I. General information

NPI: 1194645457
Provider Name (Legal Business Name): IRINA CHERNYSHKOVA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 EASTERN BLVD
GLASTONBURY CT
06033-4325
US

IV. Provider business mailing address

78 EASTERN BLVD
GLASTONBURY CT
06033-4325
US

V. Phone/Fax

Practice location:
  • Phone: 860-328-8929
  • Fax:
Mailing address:
  • Phone: 860-328-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRINA CHERNYSHKOVA
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 860-328-8929