Healthcare Provider Details

I. General information

NPI: 1538098652
Provider Name (Legal Business Name): MAXIMUS SHEVCHENKO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LIONS DR
NORTH LIBERTY IA
52317-9575
US

IV. Provider business mailing address

3 LIONS DR
NORTH LIBERTY IA
52317-9575
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-4313
  • Fax: 574-387-4313
Mailing address:
  • Phone: 574-387-4313
  • Fax: 574-387-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: