Provider Demographics
NPI:1184326738
Name:BROOME, EKATERINA SHATALOVA (MD)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:SHATALOVA
Last Name:BROOME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EKATERINA
Other - Middle Name:
Other - Last Name:SHATALOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11880 BIRD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11880 BIRD RD STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3573
Practice Address - Country:US
Practice Address - Phone:786-315-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program