Provider Demographics
NPI:1619784642
Name:SHALOMAYEV, NATANIEL
Entity type:Individual
Prefix:
First Name:NATANIEL
Middle Name:
Last Name:SHALOMAYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16607 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1203
Mailing Address - Country:US
Mailing Address - Phone:917-436-5219
Mailing Address - Fax:
Practice Address - Street 1:16607 81ST AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1203
Practice Address - Country:US
Practice Address - Phone:917-436-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program