Provider Demographics
NPI:1124389390
Name:MATAYEVA, ELYANA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELYANA
Middle Name:
Last Name:MATAYEVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAPLE STREET
Mailing Address - Street 2:PULMONARY
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06856
Mailing Address - Country:US
Mailing Address - Phone:718-441-4047
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLE STREET
Practice Address - Street 2:PULMONARY
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06856
Practice Address - Country:US
Practice Address - Phone:718-441-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63956207RC0200X, 207RP1001X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program