Provider Demographics
NPI:1740179159
Name:DEDAKHANOVA, MADINA
Entity type:Individual
Prefix:
First Name:MADINA
Middle Name:
Last Name:DEDAKHANOVA
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 1:125 MAPLE SPRING TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2173
Mailing Address - Country:US
Mailing Address - Phone:938-310-8672
Mailing Address - Fax:938-310-8672
Practice Address - Street 1:125 MAPLE SPRING TRL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2173
Practice Address - Country:US
Practice Address - Phone:938-310-8672
Practice Address - Fax:938-310-8672
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter