Provider Demographics
NPI:1407318504
Name:DEYNEHA, ALLA (RN)
Entity Type:Individual
Prefix:MISS
First Name:ALLA
Middle Name:
Last Name:DEYNEHA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 N FRANKLIN TPKE APT 17
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2008
Mailing Address - Country:US
Mailing Address - Phone:845-652-0648
Mailing Address - Fax:
Practice Address - Street 1:89 BARTLETT ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4463
Practice Address - Country:US
Practice Address - Phone:718-387-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY767088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse