Provider Demographics
NPI:1447971270
Name:DZHURAYEVA, YELIZAVETA LISA (SPECIALIST)
Entity type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:LISA
Last Name:DZHURAYEVA
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:YELIZAVETA
Other - Middle Name:LISA
Other - Last Name:DZHURAYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPECIALIST
Mailing Address - Street 1:7348 184TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1713
Mailing Address - Country:US
Mailing Address - Phone:917-370-3946
Mailing Address - Fax:
Practice Address - Street 1:7348 184TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1713
Practice Address - Country:US
Practice Address - Phone:917-370-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty