MEDICARE: INNA SHMATOV

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	174400000X	Specialist	1865176	NY
2	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1275895971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA SHMATOV

Provider Business Mailing Address
First Line	:	196 STONEGATE DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4444
Country	:	US
Telephone Number	:	646-239-6063
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 BARB ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6349
Country	:	US
Telephone Number	:	646-239-6063
Fax Number	:

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

Provider Enumeration Date	:	06/09/2012
Last Update Date	:	02/15/2026

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Directions to “ INNA SHMATOV ” Practice Location

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