Provider Demographics
NPI:1861946022
Name:SULTANOVA, AZIZA
Entity type:Individual
Prefix:
First Name:AZIZA
Middle Name:
Last Name:SULTANOVA
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 1:6210 99TH ST APT 6J
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1444
Mailing Address - Country:US
Mailing Address - Phone:347-257-5181
Mailing Address - Fax:
Practice Address - Street 1:6860 AUSTIN ST STE 306
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4223
Practice Address - Country:US
Practice Address - Phone:718-878-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator