MEDICARE: ELINA DAVIDOV FNP-BC, CEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	350625	NY
2	163W00000X	Registered Nurse	674091-1	NY

General Provider Information

NPI Number	:	1073937413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELINA DAVIDOV FNP-BC, CEN

Provider Business Mailing Address
First Line	:	5520 15TH AVE APT 6H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4312
Country	:	US
Telephone Number	:	347-423-8894
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4587
Country	:	US
Telephone Number	:	718-851-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	10/26/2022

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