Provider Demographics
NPI:1407610538
Name:AKILOVA, MICHELE TAMARA I
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:TAMARA
Last Name:AKILOVA
Suffix:I
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 1:72 GUY LOMBARDO AVE # FREEPORT
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3742
Mailing Address - Country:US
Mailing Address - Phone:516-226-3615
Mailing Address - Fax:
Practice Address - Street 1:72 GUY LOMBARDO AVE STE 2
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3742
Practice Address - Country:US
Practice Address - Phone:516-226-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY91075701163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics