Provider Demographics
NPI:1316419310
Name:SIMKHAYEV, ELIONORA
Entity type:Individual
Prefix:MRS
First Name:ELIONORA
Middle Name:
Last Name:SIMKHAYEV
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 1:11814 83RD AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1307
Mailing Address - Country:US
Mailing Address - Phone:718-825-7162
Mailing Address - Fax:
Practice Address - Street 1:11814 83RD AVE APT 4F
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1307
Practice Address - Country:US
Practice Address - Phone:718-825-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1281533181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist