Provider Demographics
NPI:1992021372
Name:SHALUMOVA, GALINA
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:SHALUMOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GALINA
Other - Middle Name:
Other - Last Name:SHALUMOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:2245 OCEAN PKWY APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4858
Mailing Address - Country:US
Mailing Address - Phone:347-275-3260
Mailing Address - Fax:
Practice Address - Street 1:2245 OCEAN PKWY APT 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4858
Practice Address - Country:US
Practice Address - Phone:347-275-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007574-1224Z00000X
NY016149-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant