Healthcare Provider Details

I. General information

NPI: 1629876362
Provider Name (Legal Business Name): EKATERINA ALEXANDROVNA SHUKH
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S FEDERAL HWY APT 122
BOCA RATON FL
33432-7311
US

IV. Provider business mailing address

1401 S FEDERAL HWY APT 122
BOCA RATON FL
33432-7311
US

V. Phone/Fax

Practice location:
  • Phone: 952-261-2425
  • Fax:
Mailing address:
  • Phone: 952-201-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: