MEDICARE: SAMIRA OVSHAEV DO PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437748332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMIRA OVSHAEV DO PC

Provider Business Mailing Address
First Line	:	4010 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4440
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4440
Country	:	US
Telephone Number	:	718-266-9779
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	SAMIRA OVSHAEV
Credential	:	DO
Telephone Number	:	718-266-9779

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	01/14/2021

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