Provider Demographics
NPI:1063837920
Name:SHIMUNOVA, BURKHO BELLA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:BURKHO
Middle Name:BELLA
Last Name:SHIMUNOVA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:BURKHO
Other - Middle Name:BELLA
Other - Last Name:SHIMUNOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3129 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1220
Mailing Address - Country:US
Mailing Address - Phone:718-487-9857
Mailing Address - Fax:
Practice Address - Street 1:3129 60TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1220
Practice Address - Country:US
Practice Address - Phone:718-487-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520330-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool