Provider Demographics
NPI:1104562727
Name:KAIYRGAZY, AGMAR (MS, RD)
Entity type:Individual
Prefix:
First Name:AGMAR
Middle Name:
Last Name:KAIYRGAZY
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4373 UNION ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3191
Mailing Address - Country:US
Mailing Address - Phone:718-886-3877
Mailing Address - Fax:718-886-3995
Practice Address - Street 1:4373 UNION ST STE 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3191
Practice Address - Country:US
Practice Address - Phone:718-886-3877
Practice Address - Fax:718-886-3995
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered