Provider Demographics
NPI:1629711429
Name:SHAMILOV, OLHA
Entity Type:Individual
Prefix:
First Name:OLHA
Middle Name:
Last Name:SHAMILOV
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 1:265 QUENTIN RD APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1621
Mailing Address - Country:US
Mailing Address - Phone:646-515-2166
Mailing Address - Fax:718-436-5138
Practice Address - Street 1:265 QUENTIN RD APT 3F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1621
Practice Address - Country:US
Practice Address - Phone:646-515-2166
Practice Address - Fax:718-436-5138
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty