Provider Demographics
NPI:1114775368
Name:SHALAMOV, MICHAL MIA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:MIA
Last Name:SHALAMOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MIHAL
Other - Middle Name:
Other - Last Name:SHALAMOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1945 ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-776-4454
Mailing Address - Fax:732-776-2344
Practice Address - Street 1:1945 ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-4454
Practice Address - Fax:732-776-2344
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program