MEDICARE: DIANA SHEYDVASSER

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	174400000X	Specialist	1206961	NY

General Provider Information

NPI Number	:	1558607036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA SHEYDVASSER

Provider Business Mailing Address
First Line	:	2263 84TH ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2263 84TH ST APT 2A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3338
Country	:	US
Telephone Number	:	347-414-1387
Fax Number	:

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

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	01/02/2013

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Directions to “ DIANA SHEYDVASSER ” Practice Location

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