MEDICARE: TAMARA SHELEVAYA-FAINSHTEIN

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	207L00000X	Anesthesiology Physician	231294-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231294-1	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1376616482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SHELEVAYA-FAINSHTEIN

Provider Business Mailing Address
First Line	:	1540 BATH AVE
Second Line	:	1A
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3823
Country	:	US
Telephone Number	:	718-232-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 BATH AVE
Second Line	:	1A
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3823
Country	:	US
Telephone Number	:	718-232-3264
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/18/2015

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