Provider Demographics
NPI:1134637317
Name:SHAMANOVA, DORA
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:SHAMANOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8514 125TH ST
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3136 88TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSONS HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11369
Practice Address - Country:US
Practice Address - Phone:718-205-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist