Provider Demographics
NPI:1205304078
Name:SHOKHINA, INNA (MS)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:SHOKHINA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CORBIN PL APT 4N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4832
Mailing Address - Country:US
Mailing Address - Phone:646-884-3804
Mailing Address - Fax:
Practice Address - Street 1:454 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4011
Practice Address - Country:US
Practice Address - Phone:347-921-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1117970171252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency