Healthcare Provider Details

I. General information

NPI: 1164383642
Provider Name (Legal Business Name): VIKTOR SHALYPIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 ASHLEY AVE
WEST SPRINGFIELD MA
01089-1302
US

IV. Provider business mailing address

15 RIDGECREST CIR
WESTFIELD MA
01085-4525
US

V. Phone/Fax

Practice location:
  • Phone: 413-693-2852
  • Fax:
Mailing address:
  • Phone: 413-777-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2345809
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: