Provider Demographics
NPI:1568043396
Name:SHALAK, SAMANTHA (RN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SHALAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038
Mailing Address - Street 2:ATTN: MCEU-BAV-CRE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ILLINOISSTRASSE
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:STUTTGART
Practice Address - Zip Code:70569
Practice Address - Country:DE
Practice Address - Phone:063-719-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001226390163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse