Healthcare Provider Details

I. General information

NPI: 1215872361
Provider Name (Legal Business Name): EKATERINA SHAKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EKATERINA NIKOLAEVNA SHAKUN

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MYSTIC LN UNIT B
MALVERN PA
19355-1942
US

IV. Provider business mailing address

502 WEST AVE APT B5
JENKINTOWN PA
19046-2891
US

V. Phone/Fax

Practice location:
  • Phone: 484-580-9213
  • Fax:
Mailing address:
  • Phone: 267-626-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: