Provider Demographics
NPI:1417317660
Name:NIYAZOVA, ELLONA (MS SP ED)
Entity Type:Individual
Prefix:
First Name:ELLONA
Middle Name:
Last Name:NIYAZOVA
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:MS
Other - First Name:ELLONA
Other - Middle Name:
Other - Last Name:NIYAZOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4277 65TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5054
Mailing Address - Country:US
Mailing Address - Phone:718-429-2000
Mailing Address - Fax:718-334-0057
Practice Address - Street 1:4277 65TH PL
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5054
Practice Address - Country:US
Practice Address - Phone:718-429-2000
Practice Address - Fax:718-334-0057
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2592776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist