Provider Demographics
NPI:1326806985
Name:MAMMADOVA, KAMILLA (MS ED)
Entity Type:Individual
Prefix:
First Name:KAMILLA
Middle Name:
Last Name:MAMMADOVA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 FOSTER AVE APT 4F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1328
Mailing Address - Country:US
Mailing Address - Phone:917-362-4603
Mailing Address - Fax:
Practice Address - Street 1:777 FOSTER AVE APT 4F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1328
Practice Address - Country:US
Practice Address - Phone:917-362-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1788954241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist