Provider Demographics
NPI:1679179477
Name:ACHILOVA, KHURSHIDA (CM, LM)
Entity Type:Individual
Prefix:
First Name:KHURSHIDA
Middle Name:
Last Name:ACHILOVA
Suffix:
Gender:F
Credentials:CM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 BRIGHTON 6TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6534
Mailing Address - Country:US
Mailing Address - Phone:718-743-7877
Mailing Address - Fax:
Practice Address - Street 1:3047 BRIGHTON 6TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6534
Practice Address - Country:US
Practice Address - Phone:718-743-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002046367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife