Provider Demographics
NPI:1316299498
Name:SHLEMANOV, DMITRIY (ARDMS)
Entity type:Individual
Prefix:
First Name:DMITRIY
Middle Name:
Last Name:SHLEMANOV
Suffix:
Gender:M
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 COURT ST. SAME DAY ULTRASOUND
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3521
Mailing Address - Country:US
Mailing Address - Phone:413-642-6373
Mailing Address - Fax:
Practice Address - Street 1:70 COURT ST. SAME DAY ULTRASOUND
Practice Address - Street 2:SUITE # 6
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3521
Practice Address - Country:US
Practice Address - Phone:413-642-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA937202471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN/AOtherN/A