Provider Demographics
NPI:1407239106
Name:MUSHEYEV, LYDIA
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:MUSHEYEV
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 1:9707 63RD RD APT 3N
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1610
Mailing Address - Country:US
Mailing Address - Phone:718-812-8112
Mailing Address - Fax:
Practice Address - Street 1:6408 FLEET ST STE BYU
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5244
Practice Address - Country:US
Practice Address - Phone:718-275-5275
Practice Address - Fax:718-275-2652
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care