Healthcare Provider Details

I. General information

NPI: 1376451922
Provider Name (Legal Business Name): RACHEL SHIMUNOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 BAY PKWY STE 2
BROOKLYN NY
11204-4750
US

IV. Provider business mailing address

705 FLANDERS DR
VALLEY STREAM NY
11581-3148
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-5948
  • Fax:
Mailing address:
  • Phone: 347-234-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: