Healthcare Provider Details

I. General information

NPI: 1164433538
Provider Name (Legal Business Name): LYUBOV B SHUR-ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 MOUNT PLEASANT RD SUITE 16 #502
CHESAPEAKE VA
23322-4043
US

IV. Provider business mailing address

1464 MOUNT PLEASANT RD SUITES 13 AND 14
CHESAPEAKE VA
23322-4043
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-4580
  • Fax: 757-410-4591
Mailing address:
  • Phone: 757-410-4580
  • Fax: 757-410-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101231492
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: