Provider Demographics
NPI:1760194039
Name:ISHKHANOVA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ISHKHANOVA
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 1:13145 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2153
Mailing Address - Country:US
Mailing Address - Phone:786-325-6219
Mailing Address - Fax:
Practice Address - Street 1:13145 CORONADO DR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2153
Practice Address - Country:US
Practice Address - Phone:786-325-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician