Provider Demographics
NPI:1609546878
Name:SHIMUNOVA, TUVA
Entity type:Individual
Prefix:MS
First Name:TUVA
Middle Name:
Last Name:SHIMUNOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10825 72ND AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7831
Mailing Address - Country:US
Mailing Address - Phone:473-561-9535
Mailing Address - Fax:
Practice Address - Street 1:10825 72ND AVE STE 1A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7831
Practice Address - Country:US
Practice Address - Phone:347-561-9535
Practice Address - Fax:347-561-9513
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003060OtherNYS LICENSE