Individual
NIKOLAY SHALASHOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4485 GREAT PLAINS DR NE, SALEM, OR 97305-3681
(503) 428-2459
Mailing address
4485 GREAT PLAINS DR NE, SALEM, OR 97305
(503) 428-2459
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
1539128
OR
Other
Enumeration date
01/14/2016
Last updated
01/14/2016
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