Provider Demographics
NPI:1275844177
Name:MIKHAYLOV, YANA
Entity Type:Individual
Prefix:DR
First Name:YANA
Middle Name:
Last Name:MIKHAYLOV
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 1:4140 FERNCREEK DR STE 601
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2569
Mailing Address - Country:US
Mailing Address - Phone:734-904-2211
Mailing Address - Fax:
Practice Address - Street 1:4140 FERNCREEK DR STE 601
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2569
Practice Address - Country:US
Practice Address - Phone:734-904-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02549208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery