Provider Demographics
NPI:1437969490
Name:SHULOV, ROMAN
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:SHULOV
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 1:4366 DALTON DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1237
Mailing Address - Country:US
Mailing Address - Phone:551-998-5729
Mailing Address - Fax:
Practice Address - Street 1:4366 DALTON DOWNS DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-1237
Practice Address - Country:US
Practice Address - Phone:551-998-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst