Provider Demographics
NPI:1255309761
Name:SHAGUMOVA, NADEZHDA (MD)
Entity Type:Individual
Prefix:DR
First Name:NADEZHDA
Middle Name:
Last Name:SHAGUMOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 OCEAN PARKWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-616-0050
Mailing Address - Fax:718-616-0065
Practice Address - Street 1:2829 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7858
Practice Address - Country:US
Practice Address - Phone:718-616-0050
Practice Address - Fax:718-616-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207429207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1839765OtherFIRST HEALTH
NY207429OtherHEALTH FIRST
NY7683488004OtherCIGNA (INTERNAL MED)
NY7880054OtherAETNA PPO
NY00001956778004OtherUNITEDHEATHCARE
NY7683488002OtherCIGNA (RHEUMATOLOGY)
NY318180301OtherHEALTH PLUS (INTERNAL MED
NY56N491OtherBC/BS
NY1000015266OtherAFFINITY
NY2355619OtherAETNA HMO (INTERNAL MED)
NYP2040069OtherOXFORD
NY318150501OtherHEALTH PLUS (RHEUMATOLOGY
NY2359536OtherAETNA HMO (RHEUMATOLOGY)
NY01925846Medicaid
NY1700138OtherGHI
NY207429OtherHORIZON HEALTH CARE
NY207429OtherHIP
NY207429OtherHIP
NY56N492Medicare ID - Type Unspecified