Healthcare Provider Details

I. General information

NPI: 1497400964
Provider Name (Legal Business Name): RAVIL VALISHEV RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 GRAVESEND NECK RD APT 4L
BROOKLYN NY
11223-5507
US

IV. Provider business mailing address

815 GRAVESEND NECK RD APT 4L
BROOKLYN NY
11223-5507
US

V. Phone/Fax

Practice location:
  • Phone: 347-465-0460
  • Fax:
Mailing address:
  • Phone: 347-465-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number647116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: