Individual provider Active NPI

Iryna Ivanovna Rahalevich, NP

  • Adult Health Nurse Practitioner
  • Shirley, NY
National Provider Identifier
1962785162
Registry record updated Dec 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F311261-01 Issued in NY
Practice address
32 Oakwood Dr
Shirley, NY 11967-3841
Phone
(631) 681-8133
NPI assigned
Sep 23, 2011
Last updated
Dec 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 648082 NY
Adult Health Nurse Practitioner 363LA2200X F311261-01 NY Primary

Addresses

Primary practice location

32 Oakwood Dr
Shirley, NY 11967-3841

Mailing address

32 Oakwood Drive
Shirley, NY 11967-3841
Phone (631) 681-8133

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)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
648082NYMDRegistered Nurse
F311261-01NYMDAdult Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733529600000",
    "number": "1962785162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 OAKWOOD DRIVE",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119673841",
            "telephone_number": "631-681-8133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 OAKWOOD DR",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119673841",
            "telephone_number": "631-681-8133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAHALEVICH",
        "first_name": "IRYNA",
        "middle_name": "IVANOVNA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-23",
        "last_updated": "2024-12-07",
        "certification_date": "2024-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "648082",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F311261-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shirley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.