Provider Demographics
NPI:1922038199
Name:SHRAYBER, YELENA Y (DO)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:Y
Last Name:SHRAYBER
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 1:10160 BUSTLETON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3749
Mailing Address - Country:US
Mailing Address - Phone:215-677-0501
Mailing Address - Fax:215-673-0409
Practice Address - Street 1:10160 BUSTLETON AVE STE B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3749
Practice Address - Country:US
Practice Address - Phone:215-677-0501
Practice Address - Fax:215-673-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07668300207Q00000X
PAOS011910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070483Medicaid
NJ0070483Medicaid