Provider Demographics
NPI:1780492991
Name:VALIKHODJAYEVA, FARIDA
Entity type:Individual
Prefix:
First Name:FARIDA
Middle Name:
Last Name:VALIKHODJAYEVA
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 1:2229 79TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2004
Mailing Address - Country:US
Mailing Address - Phone:718-673-7481
Mailing Address - Fax:
Practice Address - Street 1:2229 79TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2004
Practice Address - Country:US
Practice Address - Phone:718-673-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1859079241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist