Provider Demographics
NPI:1144253857
Name:SHKLYAR, BORIS I (DO)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:SHKLYAR
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3583 US HIGHWAY 17 BYPASS
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-357-4357
Mailing Address - Fax:843-357-4359
Practice Address - Street 1:3583 US HIGHWAY 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-357-4357
Practice Address - Fax:843-357-4359
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL998207P00000X
SCSC 998207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904184Medicaid
SC009984Medicaid
H93925Medicare UPIN
NC5904184Medicaid