Provider Demographics
NPI:1457036816
Name:GAZAROVA, SHAHZODA
Entity Type:Individual
Prefix:
First Name:SHAHZODA
Middle Name:
Last Name:GAZAROVA
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 1:1900 AVENUE W APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4742
Mailing Address - Country:US
Mailing Address - Phone:646-775-0072
Mailing Address - Fax:
Practice Address - Street 1:1900 AVENUE W APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4742
Practice Address - Country:US
Practice Address - Phone:646-775-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator