Provider Demographics
NPI:1134697345
Name:MURODOVA, MAVJUDA
Entity Type:Individual
Prefix:
First Name:MAVJUDA
Middle Name:
Last Name:MURODOVA
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 1:6282 SAUNDERS ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1531
Mailing Address - Country:US
Mailing Address - Phone:929-407-0777
Mailing Address - Fax:
Practice Address - Street 1:6282 SAUNDERS ST APT 5F
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1531
Practice Address - Country:US
Practice Address - Phone:929-407-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009849224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty