Healthcare Provider Details

I. General information

NPI: 1912836586
Provider Name (Legal Business Name): SHAWN SHALUMOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 W 5TH ST APT 2G
BROOKLYN NY
11224-4140
US

IV. Provider business mailing address

2780 W 5TH ST APT 2G
BROOKLYN NY
11224-4140
US

V. Phone/Fax

Practice location:
  • Phone: 917-873-3739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073935-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: