Provider Demographics
NPI:1730659020
Name:BABAYEVA, SUSANA (MS)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:BABAYEVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:BABAYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14715 78TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3535
Mailing Address - Country:US
Mailing Address - Phone:718-971-4961
Mailing Address - Fax:
Practice Address - Street 1:14715 78TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3535
Practice Address - Country:US
Practice Address - Phone:718-971-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1281076181252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency