Provider Demographics
NPI:1417352592
Name:KULIYEVA, SOLTANDJAMAL
Entity Type:Individual
Prefix:
First Name:SOLTANDJAMAL
Middle Name:
Last Name:KULIYEVA
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:PO BOX 26067
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0067
Mailing Address - Country:US
Mailing Address - Phone:239-624-0400
Mailing Address - Fax:239-624-0401
Practice Address - Street 1:7717 COLLIER BLVD UNIT 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-2769
Practice Address - Country:US
Practice Address - Phone:239-624-8300
Practice Address - Fax:239-624-8501
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152056207R00000X
NY289984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112019600Medicaid
FLEHU6DOtherBCBS