Provider Demographics
NPI:1588439970
Name:BOLIEVA, SHAKHNOZA
Entity type:Individual
Prefix:
First Name:SHAKHNOZA
Middle Name:
Last Name:BOLIEVA
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 1:2686 COLBY CT APT 5D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6121
Mailing Address - Country:US
Mailing Address - Phone:347-691-8006
Mailing Address - Fax:
Practice Address - Street 1:2686 COLBY CT APT 5D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6121
Practice Address - Country:US
Practice Address - Phone:347-691-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERTIFIED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist