MEDICARE: LYUDMILA V SHELESTOVSKIY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist		WA

General Provider Information

NPI Number	:	1114718228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYUDMILA V SHELESTOVSKIY

Provider Business Mailing Address
First Line	:	309 7TH ST
Second Line	:
City	:	BENTON CITY
State	:	WA
Zip	:	99320-9794
Country	:	US
Telephone Number	:	509-392-9017
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 7TH ST
Second Line	:
City	:	BENTON CITY
State	:	WA
Zip	:	99320-9794
Country	:	US
Telephone Number	:	509-392-9017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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