Provider Demographics
NPI:1841652435
Name:KAYKOVA, YAELA (MASTERS)
Entity type:Individual
Prefix:
First Name:YAELA
Middle Name:
Last Name:KAYKOVA
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15010 79TH AVE
Mailing Address - Street 2:1G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3946
Mailing Address - Country:US
Mailing Address - Phone:718-200-4455
Mailing Address - Fax:
Practice Address - Street 1:15010 79TH AVE
Practice Address - Street 2:1G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3946
Practice Address - Country:US
Practice Address - Phone:718-200-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1006317161171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator