Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME 97031 | FL |
NPI | 1053463687 |
---|---|
Provider Name | Dr. Galina Shistik |
First Address | Lakeland, FL 33805-3019 |
Second Address | Lakeland, FL 33805-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 18/09/2020 |