Provider Demographics
NPI:1831797091
Name:LEVAKOVA, YULIYA
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:LEVAKOVA
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 1:146 MACFARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4448
Mailing Address - Country:US
Mailing Address - Phone:347-615-2500
Mailing Address - Fax:
Practice Address - Street 1:146 MACFARLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4448
Practice Address - Country:US
Practice Address - Phone:347-615-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMR65774EMedicaid