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NPI Code Detail

MEDICARE: NAZIRA MAVLYANOVA

MEDICARE: NAZIRA MAVLYANOVA
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
1363A00000XPhysician AssistantMA065924PA

General Provider Information

NPI Number : 1881423366
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAZIRA MAVLYANOVA
Provider Business Mailing Address
First Line : 3509 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-4105
Country : US
Telephone Number : 347-508-1515
Fax Number :
Provider Business Practice Location Address
First Line : 7600 CENTRAL AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-2442
Country : US
Telephone Number : 215-728-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2024
Last Update Date : 01/22/2026

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Directions to “ NAZIRA MAVLYANOVA ” Practice Location

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