1992037360 NPI number — DANIEL E. SHYBUNKO, PHD., P.C.

Table of content: (NPI 1992037360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992037360 NPI number — DANIEL E. SHYBUNKO, PHD., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL E. SHYBUNKO, PHD., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992037360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24450-1068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-464-3003
Provider Business Mailing Address Fax Number:
540-464-3181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 HOUSTON ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24450-2455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-464-3003
Provider Business Practice Location Address Fax Number:
540-464-3181
Provider Enumeration Date:
02/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHYBUNKO
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-464-3003

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  0810001454 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 007754035 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com