Healthcare Provider Details

I. General information

NPI: 1174579478
Provider Name (Legal Business Name): YULIYA SHUSTOROVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JOHNSON ST STE D
HOLLYWOOD FL
33021-6052
US

IV. Provider business mailing address

3800 JOHNSON ST STE D
HOLLYWOOD FL
33021-6052
US

V. Phone/Fax

Practice location:
  • Phone: 718-612-0144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number167553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: