Provider Demographics
NPI:1952714479
Name:YUKHANANOVA, NADEZHDA
Entity Type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:YUKHANANOVA
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 1:10421 68TH DR APT B55
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3446
Mailing Address - Country:US
Mailing Address - Phone:917-660-6595
Mailing Address - Fax:
Practice Address - Street 1:10421 68TH DR APT B55
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3446
Practice Address - Country:US
Practice Address - Phone:917-660-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3620255252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency