Provider Demographics
NPI:1124326467
Name:ABAYEVA, STELLA (PA)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:ABAYEVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 THORNTON PL
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4129
Mailing Address - Country:US
Mailing Address - Phone:917-209-4244
Mailing Address - Fax:
Practice Address - Street 1:10025 QUEENS BLVD STE 1N
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2450
Practice Address - Country:US
Practice Address - Phone:718-896-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical