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General NPI Number Information
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NPI Number | 1972231405
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Entity Type | Organization
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Legal Business Name | SHAGALOV DERMATOLOGY PA
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 2800 BISCAYNE BLVD STE 1010
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City | MIAMI
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State | FL
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Zip | 33137-4559
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Country | US
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Telephone | 786-607-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 BISCAYNE BLVD
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City | MIAMI
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State | FL
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Zip | 33137-4528
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Country | US
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Telephone | 347-409-1660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEVORAH SHAGALOV
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Credential | MD
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Telephone | 415-802-1310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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