Provider Demographics
NPI:1609264233
Name:SHIMUNOV, JULIE A
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:SHIMUNOV
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 1:8804 63RD DR APT 326
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3859
Mailing Address - Country:US
Mailing Address - Phone:347-873-0564
Mailing Address - Fax:
Practice Address - Street 1:8804 63RD DR APT 326
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3859
Practice Address - Country:US
Practice Address - Phone:347-873-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist