Provider Demographics
NPI:1003416769
Name:ROFIEVA, MASHHURA
Entity Type:Individual
Prefix:
First Name:MASHHURA
Middle Name:
Last Name:ROFIEVA
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 1:1733 SHEEPSHEAD BAY RD STE 16
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3743
Mailing Address - Country:US
Mailing Address - Phone:347-252-0220
Mailing Address - Fax:
Practice Address - Street 1:1733 SHEEPSHEAD BAY RD STE 16
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3743
Practice Address - Country:US
Practice Address - Phone:347-801-2550
Practice Address - Fax:347-252-0220
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator