Provider Demographics
NPI:1871023655
Name:SHILIMOV, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:SHILIMOV
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 1:2840 OCEAN PKWY APT 2G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7950
Mailing Address - Country:US
Mailing Address - Phone:917-880-5817
Mailing Address - Fax:
Practice Address - Street 1:2840 OCEAN PKWY APT 2G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7950
Practice Address - Country:US
Practice Address - Phone:917-880-5817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14644-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014644-1OtherLICENSE#