Provider Demographics
NPI:1457819229
Name:MURDAKHAYEVA, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:MURDAKHAYEVA
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 1:13420 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2619
Mailing Address - Country:US
Mailing Address - Phone:718-206-6980
Mailing Address - Fax:
Practice Address - Street 1:6610 YELLOWSTONE BLVD APT 2H
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2033
Practice Address - Country:US
Practice Address - Phone:646-797-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY06152301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program