Individual
DIANA ILYASOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
79-25 150TH ST, APT. B11, FLUSHING, NY 11367
(347) 593-6089
Mailing address
79-25 150TH ST, APT. B11, FLUSHING, NY 11367
(347) 593-6089
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3572784
NY
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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