Healthcare Provider Details

I. General information

NPI: 1720991516
Provider Name (Legal Business Name): EMILY SHAMALOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 57TH AVE
ELMHURST NY
11373-4833
US

IV. Provider business mailing address

6836 108TH ST APT B35
FOREST HILLS NY
11375-3354
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-9060
  • Fax:
Mailing address:
  • Phone: 917-932-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: