Provider Demographics
NPI:1447928585
Name:SHMULEVICH, LILIYA (MANAGER)
Entity type:Individual
Prefix:
First Name:LILIYA
Middle Name:
Last Name:SHMULEVICH
Suffix:
Gender:F
Credentials:MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5528
Mailing Address - Country:US
Mailing Address - Phone:919-348-5880
Mailing Address - Fax:919-377-2054
Practice Address - Street 1:1410 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5528
Practice Address - Country:US
Practice Address - Phone:919-348-5880
Practice Address - Fax:919-377-2054
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-252174400000X, 311ZA0620X, 3747P1801X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174400000XOther Service ProvidersSpecialist
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant