MEDICARE: SHEFALEV VR LLC

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

General Provider Information

NPI Number	:	1780570135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEFALEV VR LLC

Provider Business Mailing Address
First Line	:	2632 W MORSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4517
Country	:	US
Telephone Number	:	718-517-1549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 W MORSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4517
Country	:	US
Telephone Number	:	718-517-1549
Fax Number	:

Authorized Official
Title or Position	:	CEO AND FOUNDER
Name	:	LIVYA BALLIN
Credential	:	RN
Telephone Number	:	718-517-1549

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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Directions to “SHEFALEV VR LLC ” Practice Location

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