Provider Demographics
NPI:1013579614
Name:YUSHUVAYEVA, OLGA (NP)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:YUSHUVAYEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:169 MADISON AVE STE 2829
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5101
Mailing Address - Country:US
Mailing Address - Phone:888-553-2823
Mailing Address - Fax:888-553-2823
Practice Address - Street 1:104-07 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6735
Practice Address - Country:US
Practice Address - Phone:888-553-2823
Practice Address - Fax:888-553-2823
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY309298363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology