Provider Demographics
NPI:1972330082
Name:SULTANOVA, ELEANORA (DOE)
Entity type:Individual
Prefix:MRS
First Name:ELEANORA
Middle Name:
Last Name:SULTANOVA
Suffix:
Gender:F
Credentials:DOE
Other - Prefix:MRS
Other - First Name:ELEANORA
Other - Middle Name:
Other - Last Name:SULTANOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ELEANORA SULTANOVA
Mailing Address - Street 1:96 ORMSBY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4018
Mailing Address - Country:US
Mailing Address - Phone:347-500-1954
Mailing Address - Fax:
Practice Address - Street 1:96 ORMSBY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-4018
Practice Address - Country:US
Practice Address - Phone:347-500-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1845255241103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst