Provider Demographics
NPI:1407087604
Name:MEHER, YEVGENIA
Entity Type:Individual
Prefix:MS
First Name:YEVGENIA
Middle Name:
Last Name:MEHER
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 1:7027 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5308
Mailing Address - Country:US
Mailing Address - Phone:602-296-7193
Mailing Address - Fax:602-296-7193
Practice Address - Street 1:7027 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5308
Practice Address - Country:US
Practice Address - Phone:602-296-7193
Practice Address - Fax:602-296-7193
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL15351064172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ90-0504160Medicare PIN