Provider Demographics
NPI:1790998102
Name:AGUVAEV, MILENA (RD)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:AGUVAEV
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MILENA
Other - Middle Name:
Other - Last Name:AGUVAEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2155 80TH ST
Mailing Address - Street 2:UNIT 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1903
Mailing Address - Country:US
Mailing Address - Phone:718-837-3569
Mailing Address - Fax:
Practice Address - Street 1:2155 80TH ST
Practice Address - Street 2:UNIT 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1903
Practice Address - Country:US
Practice Address - Phone:718-837-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
897287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered