Provider Demographics
NPI:1255682175
Name:GAME, YELENA (PA)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:GAME
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:GOLDSHEYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD EXECUTIVE PLAZA 1
Mailing Address - Street 2:STE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-4638
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:8501 ARLINGTON BLVD STE 410
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-738-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant