Provider Demographics
NPI:1699213389
Name:YUABOVA, NADEZHDA
Entity Type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:YUABOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14062 BURDEN CRES APT 3A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2344
Mailing Address - Country:US
Mailing Address - Phone:718-350-4829
Mailing Address - Fax:
Practice Address - Street 1:14062 BURDEN CRES APT 3A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-2344
Practice Address - Country:US
Practice Address - Phone:718-350-4829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1231368171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor