Provider Demographics
NPI:1134693369
Name:FUZAYLOVA, ZHANNETA (TEACHER)
Entity Type:Individual
Prefix:
First Name:ZHANNETA
Middle Name:
Last Name:FUZAYLOVA
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 METROPOLITAN AVE APT 132
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1004
Mailing Address - Country:US
Mailing Address - Phone:347-408-8039
Mailing Address - Fax:
Practice Address - Street 1:11525 METROPOLITAN AVE APT 132
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1004
Practice Address - Country:US
Practice Address - Phone:347-408-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator