Healthcare Provider Details

I. General information

NPI: 1124905179
Provider Name (Legal Business Name): NURLAN DAVLETALINOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 15TH ST. NE SUITE 104
NORTON VA
24273
US

IV. Provider business mailing address

4414 47TH AVE APT C2
WOODSIDE NY
11377-6115
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-0321
  • Fax: 276-439-1872
Mailing address:
  • Phone: 516-800-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP137752
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116041733
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: