Provider Demographics
NPI:1497400964
Name:VALISHEV, RAVIL (RN)
Entity Type:Individual
Prefix:
First Name:RAVIL
Middle Name:
Last Name:VALISHEV
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GRAVESEND NECK RD APT 4L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5507
Mailing Address - Country:US
Mailing Address - Phone:347-465-0460
Mailing Address - Fax:
Practice Address - Street 1:815 GRAVESEND NECK RD APT 4L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5507
Practice Address - Country:US
Practice Address - Phone:347-465-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY647116163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY647116Medicaid