MEDICARE: AMIRA SULEYMANOVA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	843021	NY

General Provider Information

NPI Number	:	1275356073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIRA SULEYMANOVA

Provider Business Mailing Address
First Line	:	2025 E 73RD ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6230
Country	:	US
Telephone Number	:	917-443-9407
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 E 73RD ST FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6230
Country	:	US
Telephone Number	:	917-443-9407
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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Directions to “ AMIRA SULEYMANOVA ” Practice Location

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