Provider Demographics
NPI:1922249630
Name:LEVANIDOVA, YANINA L
Entity Type:Individual
Prefix:
First Name:YANINA
Middle Name:L
Last Name:LEVANIDOVA
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 1:8360 118TH ST
Mailing Address - Street 2:APT. 2E
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2372
Mailing Address - Country:US
Mailing Address - Phone:917-443-2399
Mailing Address - Fax:
Practice Address - Street 1:26619 UNION TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1426
Practice Address - Country:US
Practice Address - Phone:187-761-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304538-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health