MEDICARE: AMIELA MORDUKHAYEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	BLANK	NY

General Provider Information

NPI Number	:	1053279265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIELA MORDUKHAYEV

Provider Business Mailing Address
First Line	:	6366 79TH ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6366 79TH ST
Second Line	:
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1310
Country	:	US
Telephone Number	:	917-655-1198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

Similar Medicare Providers

1366846271 — JOHN J SERAFINKO MASSAGE THERAPIST
Practice Location Address:

6340 79TH ST
MIDDLE VILLAGE, NY
11379-1310

Practice Phone: 917-841-8219
Practice Fax:

1700079290 — ROSEANNE LOCKWOODCAPORALE LPN
Practice Location Address:

1005 VILLAGE DR
BREWSTER, NY
10509-1310

Practice Phone: 845-612-6104
Practice Fax:

1154434819 — AMERICOAST MARYLAND LLC
Practice Location Address:

1310 INNOVATION ST STE H-L
MIDDLE RIVER, MD
21220-2179

Practice Phone: 410-202-2784
Practice Fax: 410-918-0633

1689343519 — UNIVERSITY OF MARYLAND MEDICAL REGIONAL PROFESSIONAL SERVICES, LLC
Practice Location Address:

1310 INNOVATION ST STE P&Q
MIDDLE RIVER, MD
21220-2179

Practice Phone: 410-616-1401
Practice Fax: 410-686-6915

1972461879 — MR. WILLIAM WU PHARMD CANDIDATE
Practice Location Address:

5752 74TH ST APT 2
MIDDLE VILLAGE, NY
11379-5253

Practice Phone: 347-637-0505
Practice Fax:

1700640489 — GABRIELML MENTAL HEALTH COUNSELING PC
Practice Location Address:

6350 PLEASANTVIEW ST
MIDDLE VILLAGE, NY
11379-1844

Practice Phone: 917-604-5592
Practice Fax: 718-894-0285

Directions to “ AMIELA MORDUKHAYEV ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.