Provider Demographics
NPI:1902451479
Name:SHIMONOV, MARIYA (WHNP)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:SHIMONOV
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 99TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2636
Mailing Address - Country:US
Mailing Address - Phone:347-872-8510
Mailing Address - Fax:
Practice Address - Street 1:10414 113TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2506
Practice Address - Country:US
Practice Address - Phone:718-835-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421388-01363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health