MEDICARE: MS. YELENA SHARGORODSKAYA DDS

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	122300000X	Dentist	051046	NY

General Provider Information

NPI Number	:	1245538800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YELENA SHARGORODSKAYA DDS

Provider Business Mailing Address
First Line	:	3311 SHORE PKWY APT 2L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3942
Country	:	US
Telephone Number	:	718-743-0299
Fax Number	:	718-743-1468

Provider Business Practice Location Address
First Line	:	1725 SHEEPSHEAD BAY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3606
Country	:	US
Telephone Number	:	718-743-0299
Fax Number	:	718-743-1468

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

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	03/07/2011

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