Provider Demographics
NPI:1285048660
Name:ZIYAEVA, DILRABO
Entity type:Individual
Prefix:
First Name:DILRABO
Middle Name:
Last Name:ZIYAEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 139TH ST
Mailing Address - Street 2:APT 5P
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2637
Mailing Address - Country:US
Mailing Address - Phone:347-413-4323
Mailing Address - Fax:
Practice Address - Street 1:8515 139TH ST
Practice Address - Street 2:APT 5P
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-2637
Practice Address - Country:US
Practice Address - Phone:347-413-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17OtherSEIT