Healthcare Provider Details

I. General information

NPI: 1982257523
Provider Name (Legal Business Name): MARIYA SHAVULSKIY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 808
BROOKLYN NY
11242-1108
US

IV. Provider business mailing address

26 COURT ST STE 808
BROOKLYN NY
11242-1108
US

V. Phone/Fax

Practice location:
  • Phone: 718-522-3600
  • Fax:
Mailing address:
  • Phone: 718-522-3600
  • Fax: 718-522-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF402584-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: