Healthcare Provider Details

I. General information

NPI: 1568057164
Provider Name (Legal Business Name): NATALYA VAKHIDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 BAY 17TH ST APT 3D
BROOKLYN NY
11214-5930
US

IV. Provider business mailing address

247 BAY 17TH ST APT 3D
BROOKLYN NY
11214-5930
US

V. Phone/Fax

Practice location:
  • Phone: 718-559-2894
  • Fax:
Mailing address:
  • Phone: 718-559-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: