Healthcare Provider Details

I. General information

NPI: 1205381704
Provider Name (Legal Business Name): NADEZHDA YEVDAYEVA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 AVENUE U
BROOKLYN NY
11223-4011
US

IV. Provider business mailing address

2302 AVENUE O APT D5
BROOKLYN NY
11210-5102
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-6445
  • Fax:
Mailing address:
  • Phone: 347-324-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061769-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: