Provider Demographics
NPI:1881473676
Name:KANDKHOROV, MIRYAM (SPECIAL EDUCATION)
Entity type:Individual
Prefix:MRS
First Name:MIRYAM
Middle Name:
Last Name:KANDKHOROV
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19842 EPSOM CRSE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1302
Mailing Address - Country:US
Mailing Address - Phone:718-290-5501
Mailing Address - Fax:
Practice Address - Street 1:19842 EPSOM CRSE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1302
Practice Address - Country:US
Practice Address - Phone:718-290-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist