MEDICARE: MYRA B SHAYEVITZ M.D.

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	207R00000X	Internal Medicine Physician	26725	MA

General Provider Information

NPI Number	:	1407046543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRA B SHAYEVITZ M.D.

Provider Business Mailing Address
First Line	:	4897 TANGLEWOOD LN
Second Line	:
City	:	MANLIUS
State	:	NY
Zip	:	13104-1323
Country	:	US
Telephone Number	:	315-423-5039
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 JAMES ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-2238
Country	:	US
Telephone Number	:	315-423-5039
Fax Number	:

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

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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