Healthcare Provider Details

I. General information

NPI: 1639512031
Provider Name (Legal Business Name): ROMAN MURDAKHAYEV PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 204G
BEVERLY MA
01915-6286
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 204G
BEVERLY MA
01915-6286
US

V. Phone/Fax

Practice location:
  • Phone: 978-993-1988
  • Fax:
Mailing address:
  • Phone: 978-993-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2333278
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: