Provider Demographics
NPI:1902336845
Name:GUEORGUIEVA, NEDA IANKOVA (NP)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:IANKOVA
Last Name:GUEORGUIEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 CRESCENT ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3832
Mailing Address - Country:US
Mailing Address - Phone:718-721-9570
Mailing Address - Fax:
Practice Address - Street 1:55 BROAD ST FL 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2541
Practice Address - Country:US
Practice Address - Phone:866-360-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308149363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health