Provider Demographics
NPI:1164184404
Name:GYURDZHIYANTS, ELYA
Entity Type:Individual
Prefix:
First Name:ELYA
Middle Name:
Last Name:GYURDZHIYANTS
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 1:560 FILER AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3923
Mailing Address - Country:US
Mailing Address - Phone:208-734-3001
Mailing Address - Fax:
Practice Address - Street 1:560 FILER AVE STE D
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3923
Practice Address - Country:US
Practice Address - Phone:208-734-3001
Practice Address - Fax:208-944-9293
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3747P1801X
376J00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker