Healthcare Provider Details

I. General information

NPI: 1982968814
Provider Name (Legal Business Name): OLGA SHKRAB MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 W 5TH ST APT 2F
BROOKLYN NY
11224-4167
US

IV. Provider business mailing address

2790 W 5TH ST APT 2F
BROOKLYN NY
11224-4167
US

V. Phone/Fax

Practice location:
  • Phone: 718-266-5036
  • Fax:
Mailing address:
  • Phone: 718-266-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: