Healthcare Provider Details

I. General information

NPI: 1962330464
Provider Name (Legal Business Name): LILYA MULLOKANDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 63RD RD APT 9H
REGO PARK NY
11374-1721
US

IV. Provider business mailing address

9805 63RD RD APT 9H
REGO PARK NY
11374-1721
US

V. Phone/Fax

Practice location:
  • Phone: 929-494-3206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2038908261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: