Provider Demographics
NPI:1770950347
Name:TSYBULSKIY, YELENA (NP)
Entity type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:TSYBULSKIY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:GLIKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:BOSTON UNIVERSITY - OCCUPATIONAL HEALTH CENTER
Mailing Address - Street 2:930 COMMONWEALTH AVENUE SUITE 1200
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-353-6630
Mailing Address - Fax:617-353-6848
Practice Address - Street 1:BOSTON UNIVERSITY - OCCUPATIONAL HEALTH CENTER
Practice Address - Street 2:930 COMMONWEALTH AVENUE SUITE 1200
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-353-6630
Practice Address - Fax:617-353-6848
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270350363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health