Healthcare Provider Details

I. General information

NPI: 1417861659
Provider Name (Legal Business Name): DMITRIY YABLONSKIY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 SCOTT AVE
SAINT LOUIS MO
63110-1030
US

IV. Provider business mailing address

118 STONEYSIDE LN
OLIVETTE MO
63132-4124
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1815
  • Fax:
Mailing address:
  • Phone: 314-482-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: