Provider Demographics
NPI:1437114667
Name:SHAKHANOVA, ALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:SHAKHANOVA
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 1:4241 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-967-7016
Mailing Address - Fax:718-605-4426
Practice Address - Street 1:4241 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-967-7016
Practice Address - Fax:718-605-4426
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01842346Medicaid
NY41C971Medicare ID - Type Unspecified
G64002Medicare UPIN