Provider Demographics
NPI:1619082625
Name:ILYAYEVA, STELLA (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:ILYAYEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2229
Mailing Address - Country:US
Mailing Address - Phone:718-275-2900
Mailing Address - Fax:718-275-2944
Practice Address - Street 1:9725 63RD DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2229
Practice Address - Country:US
Practice Address - Phone:718-275-2900
Practice Address - Fax:718-275-2944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211824207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02148396Medicaid
NY05948GMedicare ID - Type Unspecified
NY02148396Medicaid