MEDICARE: NADEZHDA SHATALOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1891212031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADEZHDA SHATALOVA

Provider Business Mailing Address
First Line	:	8461 W TROY ST
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-8048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35707 N 33RD LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-2289
Country	:	US
Telephone Number	:	623-445-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	08/28/2017

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Directions to “ NADEZHDA SHATALOVA ” Practice Location

Language	Start Address	Practice Location

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