Provider Demographics
NPI:1083095590
Name:YANKELEVYCH, MARIYA
Entity Type:Individual
Prefix:MRS
First Name:MARIYA
Middle Name:
Last Name:YANKELEVYCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIYA
Other - Middle Name:
Other - Last Name:SHATHKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD
Mailing Address - Street 2:SUITE 4104
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-743-9077
Mailing Address - Fax:561-743-9937
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:SUITE 4104
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-743-9077
Practice Address - Fax:561-743-9937
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9220388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner