Healthcare Provider Details

I. General information

NPI: 1801706452
Provider Name (Legal Business Name): SHALANDA MEDICAL SUPPLIES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 97TH ST
BROOKLYN NY
11209
US

IV. Provider business mailing address

310 97TH ST
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 347-656-6990
  • Fax:
Mailing address:
  • Phone: 347-656-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ZINOVI TSUKERMAN
Title or Position: OWNER
Credential:
Phone: 347-656-6990