Individual
DR. DIMITRI SHCHADENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2065 E 17TH ST STE A, IDAHO FALLS, ID 83404-8042
(800) 640-3451
Mailing address
2885 NW 10TH AVE, MERIDIAN, ID 83646-3159
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
67946
ID
363LF0000X
Family Nurse Practitioner
Primary
67946
ID
363LF0000X
Family Nurse Practitioner
95010927
CA
Other
Enumeration date
04/14/2019
Last updated
03/20/2026
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