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General NPI Number Information
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NPI Number | 1255309761
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Entity Type | Individual
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Provider Name | NADEZHDA SHAGUMOVA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 2829 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11235-7858
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Country | US
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Telephone | 718-616-0050
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Fax | 718-616-0065
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Provider Business Mailing Address
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Address Line | 2829 OCEAN PARKWAY 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235
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Country | US
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Telephone | 718-616-0050
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Fax | 718-616-0065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 207429
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License Number State | NY
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