Healthcare Provider Details

I. General information

NPI: 1033508205
Provider Name (Legal Business Name): AYUDA MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SUNRISE DR
LYNBROOK NY
11563-2920
US

IV. Provider business mailing address

54 SUNRISE DR
LYNBROOK NY
11563-2920
US

V. Phone/Fax

Practice location:
  • Phone: 516-236-4582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number212942
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAVEL G SHULMAN
Title or Position: MD
Credential: MD
Phone: 917-826-6551