Provider Demographics
NPI:1700218906
Name:SHALUMOV, SVETLANA (MSED)
Entity Type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:SHALUMOV
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5401
Mailing Address - Country:US
Mailing Address - Phone:347-249-7261
Mailing Address - Fax:
Practice Address - Street 1:1718 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5401
Practice Address - Country:US
Practice Address - Phone:347-249-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist