Individual
JACQUELENE SHATLOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-8259
Mailing address
11781 LEE JACKSON MEMORIAL HWY, STE 550, FAIRFAX, VA 22033-3309
(571) 777-5164
(703) 890-2650
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
571828
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
571828
NY
Other
Enumeration date
10/18/2013
Last updated
01/02/2024
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