Provider Demographics
NPI:1912335126
Name:KHANIEVA, DILYARA
Entity Type:Individual
Prefix:
First Name:DILYARA
Middle Name:
Last Name:KHANIEVA
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 1:3130 BRIGHTON 6TH ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6903
Mailing Address - Country:US
Mailing Address - Phone:347-497-8180
Mailing Address - Fax:
Practice Address - Street 1:420 95TH STREET
Practice Address - Street 2:WILLIAM O'CONNOR SCHOOL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-680-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program