Healthcare Provider Details

I. General information

NPI: 1063358455
Provider Name (Legal Business Name): TAMARA PRIYEV COSMETOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 WETHEROLE ST APT 3V
REGO PARK NY
11374-4739
US

IV. Provider business mailing address

6565 WETHEROLE ST APT 3V
REGO PARK NY
11374-4739
US

V. Phone/Fax

Practice location:
  • Phone: 917-345-8484
  • Fax:
Mailing address:
  • Phone: 917-345-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberAEC-24-03758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: