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NPI Code Detail

MEDICARE: VALERY SHIKVERG MD

MEDICARE: VALERY SHIKVERG MD
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
12084P0800XPsychiatry Physician155048NY

General Provider Information

NPI Number : 1366603698
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERY SHIKVERG MD
Provider Business Mailing Address
First Line : 165 COLEMAN AVE
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2217
Country : US
Telephone Number : 315-782-2061
Fax Number :
Provider Business Practice Location Address
First Line : 165 COLEMAN AVE
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2217
Country : US
Telephone Number : 315-782-2061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2008
Last Update Date : 06/19/2008

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