Provider Demographics
NPI:1720846538
Name:NOSIROVA, SHAHLO
Entity Type:Individual
Prefix:
First Name:SHAHLO
Middle Name:
Last Name:NOSIROVA
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 1:1890 E 5TH ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2814
Mailing Address - Country:US
Mailing Address - Phone:347-955-6059
Mailing Address - Fax:
Practice Address - Street 1:3035 W 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2114
Practice Address - Country:US
Practice Address - Phone:718-372-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY890535163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice