Provider Demographics
NPI:1255347597
Name:SHKURATOV, SVETLANA (MD)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:SHKURATOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GROSSMAN DR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4997
Mailing Address - Country:US
Mailing Address - Phone:781-849-2450
Mailing Address - Fax:781-849-2520
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-2450
Practice Address - Fax:187-849-2520
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2123967Medicaid
MAA40867Medicare PIN