Provider Demographics
NPI:1396375515
Name:YAGUDAYEVA, MARIYAM (MASTERSIN EDUCATION)
Entity Type:Individual
Prefix:
First Name:MARIYAM
Middle Name:
Last Name:YAGUDAYEVA
Suffix:
Gender:F
Credentials:MASTERSIN EDUCATION
Other - Prefix:
Other - First Name:MARIYAM
Other - Middle Name:
Other - Last Name:YAGUDAYEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTERS IN EDUCATION
Mailing Address - Street 1:15005 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3436
Mailing Address - Country:US
Mailing Address - Phone:971-535-6743
Mailing Address - Fax:
Practice Address - Street 1:15005 78TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3436
Practice Address - Country:US
Practice Address - Phone:971-535-6743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1371259191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty