Shushanna Yevdayev, RPH
Individual provider Active NPI Pharmacist · Brooklyn, NY
NPI 1356523401 · NPPES record last updated Nov 30, 2007
Key facts
- NPI
- 1356523401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 044560 (NY)
- Practice address
- 5102 13TH Ave
Brooklyn, NY 11219-3520 - Phone
- (718) 435-5684
- NPI assigned
- Nov 30, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044560 | NY | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 044560 | NY | Yes |
Addresses
Primary practice location
5102 13TH Ave
Brooklyn, NY 11219-3520
Mailing address
5102 13TH Ave
Brooklyn, NY 11219-3520
Phone (718) 435-5684
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01719135 | Medicaid | NY |
Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.