Provider Demographics
NPI:1912992801
Name:KHAYUT, YELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:KHAYUT
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 1:16409 SAPPHIRE PL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3115
Mailing Address - Country:US
Mailing Address - Phone:954-888-9892
Mailing Address - Fax:
Practice Address - Street 1:4350 WADSWORTH BLVD STE 301
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4634
Practice Address - Country:US
Practice Address - Phone:303-421-0194
Practice Address - Fax:303-421-6587
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049622208000000X
FLME89009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics