Provider Demographics
NPI:1518650498
Name:PANJIYEVA, BASIRA (BT)
Entity Type:Individual
Prefix:
First Name:BASIRA
Middle Name:
Last Name:PANJIYEVA
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:BESIRE
Other - Middle Name:
Other - Last Name:YUSUBOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:60 DINSMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6013
Mailing Address - Country:US
Mailing Address - Phone:508-374-3325
Mailing Address - Fax:
Practice Address - Street 1:333 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1755
Practice Address - Country:US
Practice Address - Phone:508-970-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician