Healthcare Provider Details

I. General information

NPI: 1366001257
Provider Name (Legal Business Name): ESTHER SHALAMOV FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 N 19TH AVE STE 6
PHOENIX AZ
85015-4602
US

IV. Provider business mailing address

318 W MURIEL DR
PHOENIX AZ
85023-6524
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-9191
  • Fax: 602-532-2956
Mailing address:
  • Phone: 917-660-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: