Provider Demographics
NPI:1730151754
Name:SHKLYAROVA, BELLA (MD)
Entity type:Individual
Prefix:MS
First Name:BELLA
Middle Name:
Last Name:SHKLYAROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2635 UNIVERSITY AVE
Practice Address - Street 2:STE 160 MAIL STOP 13901B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1271
Practice Address - Country:US
Practice Address - Phone:651-254-3500
Practice Address - Fax:651-254-3699
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN46410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN218658600Medicaid
MN218658600Medicaid
080013164Medicare ID - Type Unspecified