Healthcare Provider Details

I. General information

NPI: 1306632831
Provider Name (Legal Business Name): SHAKHLO SALIMOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 HULL STREET RD STE A
RICHMOND VA
23224-1714
US

IV. Provider business mailing address

6623 RIDGE BLVD APT 8E
BROOKLYN NY
11220-4809
US

V. Phone/Fax

Practice location:
  • Phone: 804-233-0007
  • Fax:
Mailing address:
  • Phone: 646-321-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401420223
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: