Provider Demographics
NPI:1396238416
Name:AIKHUELE, VICTORIA O
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:O
Last Name:AIKHUELE
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 1:71 N FRANKLIN ST STE 215
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3048
Mailing Address - Country:US
Mailing Address - Phone:516-280-7381
Mailing Address - Fax:516-280-5933
Practice Address - Street 1:71 N FRANKLIN ST STE 215
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3048
Practice Address - Country:US
Practice Address - Phone:516-280-7381
Practice Address - Fax:516-280-5933
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04119595Medicaid