Provider Demographics
NPI:1689464786
Name:ILYAYEVA, INESSA
Entity type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:ILYAYEVA
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 1:9832 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4257
Mailing Address - Country:US
Mailing Address - Phone:718-516-0000
Mailing Address - Fax:718-516-1111
Practice Address - Street 1:9832 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4257
Practice Address - Country:US
Practice Address - Phone:718-516-0000
Practice Address - Fax:718-516-1111
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician