Provider Demographics
NPI:1871304733
Name:MINAEVA, NIKA
Entity type:Individual
Prefix:
First Name:NIKA
Middle Name:
Last Name:MINAEVA
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 1:3001 S OCEAN DR APT 1235
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2873
Mailing Address - Country:US
Mailing Address - Phone:786-200-7276
Mailing Address - Fax:
Practice Address - Street 1:3001 S OCEAN DR APT 1235
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-2873
Practice Address - Country:US
Practice Address - Phone:786-200-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist