Healthcare Provider Details

I. General information

NPI: 1912992801
Provider Name (Legal Business Name): YELENA KHAYUT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 WADSWORTH BLVD STE 301
WHEAT RIDGE CO
80033-4634
US

IV. Provider business mailing address

16409 SAPPHIRE PL
WESTON FL
33331-3115
US

V. Phone/Fax

Practice location:
  • Phone: 303-421-0194
  • Fax: 303-421-6587
Mailing address:
  • Phone: 954-888-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0049622
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME89009
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: