Provider Demographics
NPI:1497467302
Name:KHAMRAKULOVA, SHAKHNOZA
Entity Type:Individual
Prefix:
First Name:SHAKHNOZA
Middle Name:
Last Name:KHAMRAKULOVA
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 1:2102 AVENUE Z STE 304
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3084
Mailing Address - Country:US
Mailing Address - Phone:929-562-9569
Mailing Address - Fax:
Practice Address - Street 1:2102 AVENUE Z STE 304
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3084
Practice Address - Country:US
Practice Address - Phone:929-562-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management