Provider Demographics
NPI:1912694043
Name:DZHESYUPOVA, GILYANA
Entity Type:Individual
Prefix:
First Name:GILYANA
Middle Name:
Last Name:DZHESYUPOVA
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 1:1660 E 21ST ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5030
Mailing Address - Country:US
Mailing Address - Phone:929-920-6264
Mailing Address - Fax:
Practice Address - Street 1:1660 E 21ST ST APT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5030
Practice Address - Country:US
Practice Address - Phone:929-920-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator