Provider Demographics
NPI:1053785089
Name:TIMOSHUK, NELYA
Entity type:Individual
Prefix:
First Name:NELYA
Middle Name:
Last Name:TIMOSHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 535770
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5770
Mailing Address - Country:US
Mailing Address - Phone:866-507-5244
Mailing Address - Fax:954-858-1815
Practice Address - Street 1:301 PROSPECT AVE.
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-299-5451
Practice Address - Fax:855-851-4405
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109333367500000X
NY579727-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine