Provider Demographics
NPI:1568071843
Name:DZHAKHNAEVA, DAYANA V
Entity Type:Individual
Prefix:MRS
First Name:DAYANA
Middle Name:V
Last Name:DZHAKHNAEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:TSEBIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:454 AVENUE U STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4032
Mailing Address - Country:US
Mailing Address - Phone:347-921-3250
Mailing Address - Fax:347-779-0433
Practice Address - Street 1:454 AVENUE U STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4032
Practice Address - Country:US
Practice Address - Phone:347-921-3250
Practice Address - Fax:347-779-0433
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY225519835OtherNYS IDENTIFICATION CARD