Individual provider Active NPI

Shamir Khaitov

  • Registered Nurse
  • Brooklyn, NY
National Provider Identifier
1710835640
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
777765-01 Issued in NY
Practice address
1914 Bay Ave Apt 2B
Brooklyn, NY 11230-6212
Phone
(718) 844-9454
NPI assigned
Mar 17, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NR24855100 NJ
Registered Nurse 163W00000X 777765-01 NY Primary

Addresses

Primary practice location

1914 Bay Ave Apt 2B
Brooklyn, NY 11230-6212

Mailing address

1914 Bay Ave Apt 2B
Brooklyn, NY 11230-6212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
26NR24855100NJMDRegistered Nurse
777765-01NYMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1710835640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 BAY AVE APT 2B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1914 BAY AVE APT 2B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306212",
            "telephone_number": "718-844-9454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAITOV",
        "first_name": "SHAMIR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-17",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR24855100",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "777765-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.