Provider Demographics
NPI:1467664896
Name:SHKOLNIKOV, LILLA (MD)
Entity Type:Individual
Prefix:
First Name:LILLA
Middle Name:
Last Name:SHKOLNIKOV
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 1:4548 DEER TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5608
Mailing Address - Country:US
Mailing Address - Phone:941-924-0049
Mailing Address - Fax:941-924-0049
Practice Address - Street 1:4548 DEER TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5608
Practice Address - Country:US
Practice Address - Phone:941-924-0049
Practice Address - Fax:941-924-0049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43831208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF43778Medicare UPIN
FL18074AMedicare ID - Type Unspecified