Provider Demographics
NPI:1437349347
Name:ILYAYEVA, ANZHELIKA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ANZHELIKA
Middle Name:
Last Name:ILYAYEVA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 BEACH 96 STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:11693
Mailing Address - Country:US
Mailing Address - Phone:347-393-9555
Mailing Address - Fax:
Practice Address - Street 1:168 BEACH 96 STREET
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:11693
Practice Address - Country:US
Practice Address - Phone:347-393-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567896163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02709135Medicaid