Provider Demographics
NPI:1548796287
Name:BENYAMINOV, YELENA (PA)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:BENYAMINOV
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SOM CENTER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2362
Mailing Address - Country:US
Mailing Address - Phone:440-461-6477
Mailing Address - Fax:440-461-1017
Practice Address - Street 1:730 SOM CENTER RD STE 230
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2362
Practice Address - Country:US
Practice Address - Phone:440-461-6477
Practice Address - Fax:440-461-1017
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005027RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant