Provider Demographics
NPI:1043804479
Name:SHAMALOV, SONYA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:SHAMALOV
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14127 78TH RD APT 2D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3344
Mailing Address - Country:US
Mailing Address - Phone:347-320-4835
Mailing Address - Fax:
Practice Address - Street 1:14127 78TH RD APT 2D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3344
Practice Address - Country:US
Practice Address - Phone:347-320-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86156817133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered