MEDICARE: LAURA SHAMAILOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	523426	NY

General Provider Information

NPI Number	:	1447910237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA SHAMAILOV

Provider Business Mailing Address
First Line	:	107 PELICAN CIR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 PELICAN CIR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4567
Country	:	US
Telephone Number	:	917-695-2955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	12/21/2021

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Directions to “ LAURA SHAMAILOV ” Practice Location

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