Provider Demographics
NPI:1508267485
Name:DAVYDOVA, YELENA (DO)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:DAVYDOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CORTELYOU RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5243
Mailing Address - Country:US
Mailing Address - Phone:718-282-0900
Mailing Address - Fax:
Practice Address - Street 1:800 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5243
Practice Address - Country:US
Practice Address - Phone:718-282-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1811968993207Q00000X
NY290258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine