Provider Demographics
NPI:1225808322
Name:KHAYITOVA, MAFTUNA
Entity Type:Individual
Prefix:MISS
First Name:MAFTUNA
Middle Name:
Last Name:KHAYITOVA
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 1:1735 E 13TH ST APT 3H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1949
Mailing Address - Country:US
Mailing Address - Phone:646-829-8370
Mailing Address - Fax:
Practice Address - Street 1:1735 E 13TH ST APT 3H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1949
Practice Address - Country:US
Practice Address - Phone:646-829-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY830242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse