Provider Demographics
NPI:1992022008
Name:BABAYEV, REVEKKA
Entity Type:Individual
Prefix:
First Name:REVEKKA
Middle Name:
Last Name:BABAYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REVEKKA
Other - Middle Name:
Other - Last Name:NIYAZOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4550
Mailing Address - Country:US
Mailing Address - Phone:203-324-7666
Mailing Address - Fax:203-323-2541
Practice Address - Street 1:30 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4550
Practice Address - Country:US
Practice Address - Phone:203-324-7666
Practice Address - Fax:203-323-2541
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54198207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology