DMITRIY SHISHKIN (NPI# 1891230371) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891230371 |
| Entity Type | Individual |
| Full Name | DMITRIY SHISHKIN |
| Practice Address |
253 Bayberry Lakes Blvd Daytona Beach FL 32124-3620 |
| Practice Telephone | 3863344730 |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2016-12-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
9288346 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
253 BAYBERRY LAKES BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32124-3620 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407302599 | Christine Lapila | Behavioral Analyst | 201 Thornberg Branch Lane, Daytona Beach, FL 32124 | 2016-08-29 |
| 1194708495 | Brent N. Fulton | Family Medicine | 3127 W International Speedway Blvd., Daytona Beach, FL 32124 | 2005-11-21 |
| 1891212130 | Brian Moore | Early Intervention Provider Agency | 201 Thornberry Branch Ln, Daytona Beach, FL 32124 | 2017-08-28 |
| 1588834725 | Glendoria Stephens | Counselor | 3875 Tiger Bay Rd, Rm 914 Bldg I, Daytona Beach, FL 32124 | 2008-03-04 |
| 1003146887 | Sequel Tsi of Florida, LLC Daytona Transitional | Residential Treatment Facility, Emotionally Disturbed Children | 1386 Indian Lake Rd, Daytona Beach, FL 32124-1001 | 2009-12-30 |
| 1376874370 | Sequel Tsi of Florida, LLC Daytona Residential Treatment Center | Psychiatric Residential Treatment Facility | 1386 Indian Lake Rd, Daytona Beach, FL 32124-1001 | 2010-01-15 |
| 1710531454 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 2630 Lpga Blvd, Daytona Beach, FL 32124-1008 | 2019-07-31 |
| 1336746544 | Kyle Adams | Pharmacist | 2630 Lpga Blvd, Daytona Beach, FL 32124-1008 | 2020-10-01 |
| 1750369666 | Sma Healthcare Inc | Community/Behavioral Health | 1150 Red John Road, Daytona Beach, FL 32124-1016 | 2006-01-03 |
| 1396742490 | Theodore Frank Matejka | Nurse Practitioner | 1150 Red John Dr, Daytona Beach, FL 32124-1016 | 2005-07-05 |
| Find all providers in zip 32124 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285805804 | Sylvia S. Quandt | Nurse Practitioner | 1200 Red John Dr, Daytona Beach, FL 32124-1073 | 2008-03-23 |
| 1952499287 | Natalie K Eisenhut | Nurse Practitioner | 1040 W International Speedway Blvd, Daytona Beach, FL 32114-3434 | 2006-10-11 |
| 1396742490 | Theodore Frank Matejka | Nurse Practitioner | 1150 Red John Dr, Daytona Beach, FL 32124-1016 | 2005-07-05 |
| 1588200885 | Kathryn Anne Erickson | Nurse Practitioner | 1630 Mason Ave Ste C, Daytona Beach, FL 32117-4503 | 2019-11-21 |
| 1225532336 | Kristine Mcgowan | Nurse Practitioner | 305 Memorial Medical Pkwy Ste 502, Daytona Beach, FL 32117-5169 | 2018-03-22 |
| 1659886646 | Tenisha Bryan Morris | Nurse Practitioner | 1630 Mason Ave Ste C, Daytona Beach, FL 32117 | 2017-12-12 |
| 1366991812 | Melissa Renae Clegg | Nurse Practitioner | 305 Memorial Medical Pkwy, Suite 301, Daytona Beach, FL 32117-5168 | 2016-09-26 |
| 1548614647 | Emma Laura Ems | Nurse Practitioner | 1630 Mason Ave Ste C, Daytona Beach, FL 32117 | 2016-04-15 |
| 1669808861 | Robin P Brown | Nurse Practitioner | 303 N Clyde Morris Blvd, Daytona Beach, FL 32114-2709 | 2013-09-19 |
| 1225333529 | Maryjane Mclaughlin | Nurse Practitioner | 303 North Clyde Morris Blvd., Halifax Health Medical Center, Daytona Beach, FL 32114-2709 | 2011-01-18 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32124 |
Please comment or provide details below to improve the information on DMITRIY SHISHKIN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.