Healthcare Provider Details

I. General information

NPI: 1942723564
Provider Name (Legal Business Name): MICHELLE ILYAYEV LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 DURHAM RD
EAST MEADOW NY
11554-4604
US

IV. Provider business mailing address

713 DURHAM RD
EAST MEADOW NY
11554-4604
US

V. Phone/Fax

Practice location:
  • Phone: 917-977-0122
  • Fax:
Mailing address:
  • Phone: 917-977-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP03155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: