Provider Demographics
NPI:1154196525
Name:MAVLONKULOVA, SHOKHSANAM
Entity type:Individual
Prefix:
First Name:SHOKHSANAM
Middle Name:
Last Name:MAVLONKULOVA
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 1:1770 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2043
Mailing Address - Country:US
Mailing Address - Phone:892-958-0970
Mailing Address - Fax:
Practice Address - Street 1:1770 E 14TH ST APT 7E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2064
Practice Address - Country:US
Practice Address - Phone:892-958-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY897183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse