Provider Demographics
NPI:1417472374
Name:YAGOUDAEVA, NATELLA
Entity Type:Individual
Prefix:
First Name:NATELLA
Middle Name:
Last Name:YAGOUDAEVA
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 1:6560 WETHEROLE ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4725
Mailing Address - Country:US
Mailing Address - Phone:347-408-8488
Mailing Address - Fax:
Practice Address - Street 1:65-60 WETHEROLE ST. APT 4D
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:347-408-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant