Provider Demographics
NPI:1679249304
Name:YAGUDAEV, ELIZABETH (SI (MS,ED))
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:YAGUDAEV
Suffix:
Gender:F
Credentials:SI (MS,ED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4536
Mailing Address - Country:US
Mailing Address - Phone:347-542-9500
Mailing Address - Fax:
Practice Address - Street 1:11023 71ST AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4536
Practice Address - Country:US
Practice Address - Phone:347-542-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist