Active NPI
Andrei R Shustov, MD
- Hematology & Oncology Physician
- Seattle, WA
National Provider Identifier
1346247632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- MD00042672
- Practice address
- 825 Eastlake Avenue E
G3-200
Seattle, WA 98109-1023 - Phone
- (206) 288-6739
- Fax
- (206) 288-6473
- NPI assigned
- Jul 1, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | MD00042672 | WA | Primary |
Addresses
Primary practice location
825 Eastlake Avenue E
G3-200
Seattle, WA 98109-1023
Mailing address
825 Eastlake Avenue E
G3-200
Seattle, WA 98109-1023
Phone (206) 288-6739
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8421596 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00042672 | WA | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212019200000",
"number": "1346247632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 EASTLAKE AVENUE E",
"address_2": "G3-200",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981091023",
"telephone_number": "206-288-6739",
"fax_number": "206-288-6473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 EASTLAKE AVENUE E",
"address_2": "G3-200",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981091023",
"telephone_number": "206-288-6739",
"fax_number": "206-288-6473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUSTOV",
"first_name": "ANDREI",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-01",
"last_updated": "2008-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "WA",
"license": "MD00042672",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8421596",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.