Healthcare Provider Details

I. General information

NPI: 1932399144
Provider Name (Legal Business Name): MIKHAIL SHAMAYEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9922 ROOSEVELT BLVD
PHILADELPHIA PA
19115-1705
US

IV. Provider business mailing address

9922 ROOSEVELT BLVD
PHILADELPHIA PA
19115-1705
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-2000
  • Fax: 215-464-6046
Mailing address:
  • Phone: 215-464-2000
  • Fax: 215-464-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD432308
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: