MEDICARE: AVITAL NIYAZOVA RN

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	163WH0200X	Home Health Registered Nurse	994439	NY

General Provider Information

NPI Number	:	1689524811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVITAL NIYAZOVA RN

Provider Business Mailing Address
First Line	:	6711 YELLOWSTONE BLVD APT 3B
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 YELLOWSTONE BLVD APT 3B
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2313
Country	:	US
Telephone Number	:	917-945-1999
Fax Number	:

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

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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