Provider Demographics
NPI:1316185747
Name:YAKOVLEVA, TATYANA
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:YAKOVLEVA
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 1:2940 BRIGHTON 5TH ST
Mailing Address - Street 2:STE#C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8530
Mailing Address - Country:US
Mailing Address - Phone:917-602-7264
Mailing Address - Fax:
Practice Address - Street 1:2940 BRIGHTON 5TH ST
Practice Address - Street 2:STE#C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8530
Practice Address - Country:US
Practice Address - Phone:917-602-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002339171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist