MEDICARE: MS. PARIZA YUSUPOVA

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	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1629907514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PARIZA YUSUPOVA

Provider Business Mailing Address
First Line	:	6401 24TH AVE APT G2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 24TH AVE APT G2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3418
Country	:	US
Telephone Number	:	929-350-0808
Fax Number	:

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

Provider Enumeration Date	:	05/16/2026
Last Update Date	:	05/16/2026

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