Provider Demographics
NPI:1396709895
Name:SHUNYAKOV, LEONID (MD)
Entity type:Individual
Prefix:DR
First Name:LEONID
Middle Name:
Last Name:SHUNYAKOV
Suffix:
Gender:M
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:785-823-0658
Practice Address - Street 1:1501 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3020
Practice Address - Country:US
Practice Address - Phone:417-326-7200
Practice Address - Fax:417-326-7201
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31660207RX0202X, 207RH0003X
MO2005002905207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507606309Medicaid
MO2005002905OtherMD LICENSE
MOBS9253814OtherDEA
MO2005002905OtherMD LICENSE
MO507606309Medicaid