MEDICARE: MISS NATALIYA S SHTYKOVA RN

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	164W00000X	Licensed Practical Nurse	295267-1	NY
2	163W00000X	Registered Nurse	652090	NY

General Provider Information

NPI Number	:	1538496005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATALIYA S SHTYKOVA RN

Provider Business Mailing Address
First Line	:	1815 E 17TH ST APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2958
Country	:	US
Telephone Number	:	937-231-9767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 E 17TH ST APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2958
Country	:	US
Telephone Number	:	937-231-9767
Fax Number	:

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	08/14/2012

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