Provider Demographics
NPI:1295814127
Name:KHANUKAYEV, MARIA (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KHANUKAYEV
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 SIXTH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-9008
Mailing Address - Country:US
Mailing Address - Phone:718-780-5942
Mailing Address - Fax:
Practice Address - Street 1:506 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-9008
Practice Address - Country:US
Practice Address - Phone:718-780-5942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011364363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical