Provider Demographics
NPI:1700081692
Name:SHKLYAREVSKY, VICTOR JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JOSEPH
Last Name:SHKLYAREVSKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3027
Mailing Address - Country:US
Mailing Address - Phone:610-651-0551
Mailing Address - Fax:610-651-0392
Practice Address - Street 1:41 LEOPARD RD
Practice Address - Street 2:PAOLI EXECUTIVE GREEN I, SUITE 304
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1549
Practice Address - Country:US
Practice Address - Phone:610-647-6406
Practice Address - Fax:610-407-0302
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008850L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical