Provider Demographics
NPI:1962785162
Name:RAHALEVICH, IRYNA IVANOVNA (NP)
Entity type:Individual
Prefix:MRS
First Name:IRYNA
Middle Name:IVANOVNA
Last Name:RAHALEVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OAKWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3841
Mailing Address - Country:US
Mailing Address - Phone:631-681-8133
Mailing Address - Fax:
Practice Address - Street 1:32 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3841
Practice Address - Country:US
Practice Address - Phone:631-681-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648082163W00000X
NYF311261-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse