Provider Demographics
NPI:1386173623
Name:MOISEEVA, AIDA (MS)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:MOISEEVA
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5989 NW 74TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2450
Mailing Address - Country:US
Mailing Address - Phone:347-524-7802
Mailing Address - Fax:
Practice Address - Street 1:5989 NW 74TH ST
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2450
Practice Address - Country:US
Practice Address - Phone:347-524-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL1429615222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT221-400-81-567-0OtherITDS