Provider Demographics
NPI:1689203101
Name:YANISHEVSKI, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:YANISHEVSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 POPLAR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3806
Mailing Address - Country:US
Mailing Address - Phone:901-757-3535
Mailing Address - Fax:
Practice Address - Street 1:7465 POPLAR AVE STE 201
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3806
Practice Address - Country:US
Practice Address - Phone:901-757-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN67651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics