Basic Information
| Provider Information | |||||||||
| NPI: | 1053785089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIMOSHUK | ||||||||
| FirstName: | NELYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 535770 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303535770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665075244 | ||||||||
| FaxNumber: | 9548581815 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 PROSPECT AVE. | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152995451 | ||||||||
| FaxNumber: | 8558514405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2015 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 109333 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163WC0200X | 579727-1 | NY | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.