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Individual
GENNADIY SHAMALOV
Active
Individual
GENNADIY SHAMALOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
008219-1
NY
Other
Enumeration date
01/03/2007
Last updated
09/25/2012
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