Provider Demographics
NPI:1992283006
Name:SHEVCHENKO, OLEXANDRA OLEGIVNA
Entity type:Individual
Prefix:
First Name:OLEXANDRA
Middle Name:OLEGIVNA
Last Name:SHEVCHENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 JACKSON HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-7433
Mailing Address - Country:US
Mailing Address - Phone:281-825-2091
Mailing Address - Fax:
Practice Address - Street 1:602 W SEMANDS ST # 128
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1867
Practice Address - Country:US
Practice Address - Phone:832-622-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX791309163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse