Individual
DR. IRINA SHAMALOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2071 2ND AVE, NEW YORK, NY 10029-4101
(212) 410-6969
(212) 410-6989
Mailing address
9941 64TH AVE, APT. A12, REGO PARK, NY 11374-2653
(917) 749-6330
(212) 410-6989
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
052022-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02771093
—
NY
01
—
9184884
DORAL
NY
Enumeration date
01/22/2007
Last updated
07/08/2007
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