Provider Demographics
NPI:1952826497
Name:SHATS, YELENA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:SHATS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5109
Mailing Address - Country:US
Mailing Address - Phone:917-470-4455
Mailing Address - Fax:
Practice Address - Street 1:2076 HYLAN BLVD # 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3427
Practice Address - Country:US
Practice Address - Phone:718-351-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily