Healthcare Provider Details

I. General information

NPI: 1669438941
Provider Name (Legal Business Name): YEVGENIYA SHURP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MORRISEY DRIVE
PUTNAM VALLEY NY
10579
US

IV. Provider business mailing address

195 N BEDFORD RD STE 6
MOUNT KISCO NY
10549-1149
US

V. Phone/Fax

Practice location:
  • Phone: 845-528-5222
  • Fax: 845-528-8589
Mailing address:
  • Phone: 212-226-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number207317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: