Healthcare Provider Details

I. General information

NPI: 1881423366
Provider Name (Legal Business Name): NAZIRA MAVLYANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CENTRAL AVE
PHILADELPHIA PA
19111-2442
US

IV. Provider business mailing address

85 E ENDFIELD RD
FEASTERVILLE TREVOSE PA
19053-2338
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2273
  • Fax:
Mailing address:
  • Phone: 347-508-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: