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General NPI Number Information
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NPI Number | 1750813499
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Entity Type | Individual
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Provider Name | ANDREY SHALOMOV M.D., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 1103 N GRAY ST
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City | KILLEEN
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State | TX
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Zip | 76541-3420
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Country | US
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Telephone | 254-774-1163
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Fax | 833-464-5455
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Provider Business Mailing Address
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Address Line | 1103 N GRAY ST
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City | KILLEEN
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State | TX
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Zip | 76541-3420
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Country | US
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Telephone | 254-774-1163
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Fax | 833-464-5455
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | S6040
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | S6040
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License Number State | TX
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