Provider Demographics
NPI:1740983469
Name:YELLAYI, DISHA
Entity type:Individual
Prefix:
First Name:DISHA
Middle Name:
Last Name:YELLAYI
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 1:2910 BROADWAY APT 4D
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3076
Mailing Address - Country:US
Mailing Address - Phone:716-533-0463
Mailing Address - Fax:
Practice Address - Street 1:500 HOFSTRA BLVD
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11549-0001
Practice Address - Country:US
Practice Address - Phone:516-463-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program