Provider Demographics
NPI:1386190510
Name:YELEVICH-IZNYUK, TATYANA (MA, SP ED, TSHH)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:YELEVICH-IZNYUK
Suffix:
Gender:F
Credentials:MA, SP ED, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598
Mailing Address - Country:US
Mailing Address - Phone:917-299-0969
Mailing Address - Fax:
Practice Address - Street 1:3215 COURT ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-2503
Practice Address - Country:US
Practice Address - Phone:917-299-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY394380031174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator