Provider Demographics
NPI:1346598703
Name:RAFAILOVA, SOFIYA
Entity Type:Individual
Prefix:
First Name:SOFIYA
Middle Name:
Last Name:RAFAILOVA
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 1:15010 79TH AVE APT 1G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3915
Mailing Address - Country:US
Mailing Address - Phone:718-350-5977
Mailing Address - Fax:
Practice Address - Street 1:15010 79TH AVE APT 1G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3915
Practice Address - Country:US
Practice Address - Phone:718-350-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist