Provider Demographics
NPI:1063042273
Name:KAYKOVA, ANZHELA
Entity Type:Individual
Prefix:
First Name:ANZHELA
Middle Name:
Last Name:KAYKOVA
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 1:12360 83RD AVE APT 10R
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3417
Mailing Address - Country:US
Mailing Address - Phone:646-696-7400
Mailing Address - Fax:718-205-3330
Practice Address - Street 1:6613 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5224
Practice Address - Country:US
Practice Address - Phone:718-205-0664
Practice Address - Fax:718-205-3330
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000043654237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist