Provider Demographics
NPI:1205113164
Name:FUZAILOVA, MAYA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:FUZAILOVA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 EAST 10 STREET #4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2841
Mailing Address - Country:US
Mailing Address - Phone:718-909-7308
Mailing Address - Fax:
Practice Address - Street 1:35 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5004
Practice Address - Country:US
Practice Address - Phone:171-843-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641365163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse