Provider Demographics
NPI:1720365760
Name:SHAGISULTANOVA, ELENA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:SHAGISULTANOVA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 AURORA CT
Mailing Address - Street 2:MAIL STOP F704, ANSCHUTZ CANCER PAVILION (ACP), CP 5328
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2517
Mailing Address - Country:US
Mailing Address - Phone:858-722-9600
Mailing Address - Fax:
Practice Address - Street 1:1665 AURORA CT
Practice Address - Street 2:MAIL STOP F704, ANSCHUTZ CANCER PAVILION (ACP), CP 5328
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2517
Practice Address - Country:US
Practice Address - Phone:858-722-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118631207R00000X
PAMD447066207R00000X
CO55547207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine