Provider Demographics
NPI:1497491849
Name:MATHEW, SHALAKA
Entity Type:Individual
Prefix:
First Name:SHALAKA
Middle Name:
Last Name:MATHEW
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:SUNY DOWNSTATE, 450 CLARKSON AVENUE
Mailing Address - Street 2:INTERNAL MEDICINE DEPARTMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-1566
Mailing Address - Fax:
Practice Address - Street 1:SUNY DOWNSTATE, 450 CLARKSON AVENUE
Practice Address - Street 2:INTERNAL MEDICINE DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program