Provider Demographics
NPI:1679895338
Name:SHABLYA, YELENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:SHABLYA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 OCEAN AVE
Mailing Address - Street 2:APT 3K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3030
Mailing Address - Country:US
Mailing Address - Phone:908-812-4247
Mailing Address - Fax:
Practice Address - Street 1:253 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2926
Practice Address - Country:US
Practice Address - Phone:212-254-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist