Provider Demographics
NPI:1164383642
Name:SHALYPIN, VIKTOR
Entity type:Individual
Prefix:
First Name:VIKTOR
Middle Name:
Last Name:SHALYPIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RIDGECREST CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4525
Mailing Address - Country:US
Mailing Address - Phone:413-777-0353
Mailing Address - Fax:
Practice Address - Street 1:86 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1302
Practice Address - Country:US
Practice Address - Phone:413-693-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN23458092085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology