Provider Demographics
NPI:1720586787
Name:NURIZADE, ANASTASIA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:NURIZADE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 ARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3033
Mailing Address - Country:US
Mailing Address - Phone:347-452-0179
Mailing Address - Fax:
Practice Address - Street 1:620 ARDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3033
Practice Address - Country:US
Practice Address - Phone:347-452-0179
Practice Address - Fax:347-452-0179
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11728006103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst