Provider Demographics
NPI:1700268778
Name:SHALUKHOVA, MARIA (AGNP, PMHNP)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:SHALUKHOVA
Suffix:
Gender:F
Credentials:AGNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BANK ST APT 212B
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-7004
Mailing Address - Country:US
Mailing Address - Phone:716-380-7874
Mailing Address - Fax:
Practice Address - Street 1:25 BANK ST APT 212B
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-7004
Practice Address - Country:US
Practice Address - Phone:716-380-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404459363LP0808X
NY307294363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health