Provider Demographics
NPI:1710110820
Name:CHERNYAK, ELINA (DO)
Entity Type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:CHERNYAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-0189
Mailing Address - Country:US
Mailing Address - Phone:509-758-5511
Mailing Address - Fax:509-758-3566
Practice Address - Street 1:302 5TH ST STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1801
Practice Address - Country:US
Practice Address - Phone:509-769-2211
Practice Address - Fax:509-769-2210
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9521A207QA0401X
CO48154208D00000X
IDOC-0034207QA0401X
OH34.010590207QA0401X
PAOS015088207QA0401X
UT9495192-1204207QA0401X
WAOP60945031207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice