Provider Demographics
NPI:1669837225
Name:KHODZHAYEVA, LYUDMILA
Entity type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:
Last Name:KHODZHAYEVA
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 1:18725 PERTH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5814
Mailing Address - Country:US
Mailing Address - Phone:917-603-0995
Mailing Address - Fax:
Practice Address - Street 1:18725 PERTH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5814
Practice Address - Country:US
Practice Address - Phone:917-603-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023862-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist