Provider Demographics
NPI:1093373466
Name:SULEYMANOVA, ELANA (SC)
Entity Type:Individual
Prefix:MISS
First Name:ELANA
Middle Name:
Last Name:SULEYMANOVA
Suffix:
Gender:F
Credentials:SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 185TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2119
Mailing Address - Country:US
Mailing Address - Phone:347-837-7762
Mailing Address - Fax:
Practice Address - Street 1:24902 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4023
Practice Address - Country:US
Practice Address - Phone:347-837-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator