Provider Demographics
NPI:1124478342
Name:YEVDAYEV, SHIMON (LMT)
Entity type:Individual
Prefix:MR
First Name:SHIMON
Middle Name:
Last Name:YEVDAYEV
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 E 16TH ST APT 5H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4045
Mailing Address - Country:US
Mailing Address - Phone:917-216-6961
Mailing Address - Fax:
Practice Address - Street 1:1812 QUENTIN RD FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1367
Practice Address - Country:US
Practice Address - Phone:347-277-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
NY028836173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist