Provider Demographics
NPI:1992921787
Name:SHTOFF, LYUDMILA (MD)
Entity type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:SHTOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYUDMILA
Other - Middle Name:
Other - Last Name:RYABOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:VAMC, WADE PARK, PRIMARY CARE CLINIC
Mailing Address - Street 2:10701 EAST BLVD
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-791-3800
Mailing Address - Fax:216-229-2327
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:VAMC, WADE PARK, PRIMARY CARE CLINIC
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-229-2327
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00862207R00000X
OH35-096612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3114507Medicaid
OH3114507Medicaid