Healthcare Provider Details

I. General information

NPI: 1255309761
Provider Name (Legal Business Name): NADEZHDA SHAGUMOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 OCEAN PKWY
BROOKLYN NY
11235-7858
US

IV. Provider business mailing address

2829 OCEAN PARKWAY 2ND FLOOR
BROOKLYN NY
11235
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-0050
  • Fax: 718-616-0065
Mailing address:
  • Phone: 718-616-0050
  • Fax: 718-616-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number207429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: