Provider Demographics
NPI:1750813499
Name:SHALOMOV, ANDREY (MD, MPH)
Entity type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:SHALOMOV
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0011
Mailing Address - Country:US
Mailing Address - Phone:254-774-1163
Mailing Address - Fax:833-464-5455
Practice Address - Street 1:1103 N GRAY ST
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-3420
Practice Address - Country:US
Practice Address - Phone:254-774-1163
Practice Address - Fax:833-464-5455
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS60402084P0804X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty