Provider Demographics
NPI:1033096326
Name:SHALMIYEVA, KHALIDA
Entity type:Individual
Prefix:MRS
First Name:KHALIDA
Middle Name:
Last Name:SHALMIYEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 EMMONS AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1165
Mailing Address - Country:US
Mailing Address - Phone:917-655-0503
Mailing Address - Fax:
Practice Address - Street 1:704 AVENUE X FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6121
Practice Address - Country:US
Practice Address - Phone:718-676-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY588190609171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator