MEDICARE: MRS. IREN SHEMELYAK LC. AC.

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	320700000X	Physical Disabilities Residential Treatment Facility	001998	NY

General Provider Information

NPI Number	:	1518169648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IREN SHEMELYAK LC. AC.

Provider Business Mailing Address
First Line	:	2958 W 8TH ST
Second Line	:	SUITE 20J
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3223
Country	:	US
Telephone Number	:	646-644-9780
Fax Number	:	718-426-4240

Provider Business Practice Location Address
First Line	:	6127 WOODSIDE AVE
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-3542
Country	:	US
Telephone Number	:	646-644-9780
Fax Number	:	718-426-4240

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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