Healthcare Provider Details

I. General information

NPI: 1396709895
Provider Name (Legal Business Name): LEONID SHUNYAKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N OAKLAND AVE
BOLIVAR MO
65613-3020
US

IV. Provider business mailing address

PO BOX 256
SALINA KS
67402-0256
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-7200
  • Fax: 417-326-7201
Mailing address:
  • Phone: 785-823-0633
  • Fax: 785-823-0658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number04-31660
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2005002905
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2005002905
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-31660
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: