Individual
AKETA SHALLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
137 E 35TH ST, BROOKLYN, NY 11203-2718
(917) 476-9308
Mailing address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(917) 476-9308
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
961167397
DRIVERS LICENSE
NY
Enumeration date
06/16/2021
Last updated
06/16/2021
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