Provider Demographics
NPI:1649975491
Name:YATSENKO, TATYANA ALEXANDROVNA (MD)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:ALEXANDROVNA
Last Name:YATSENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SCHERMERHORN ST APT 17G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3492
Mailing Address - Country:US
Mailing Address - Phone:713-715-8463
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 2100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2769
Practice Address - Country:US
Practice Address - Phone:713-441-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program