Healthcare Provider Details

I. General information

NPI: 1144142514
Provider Name (Legal Business Name): NADYA DAVIDOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 YELLOWSTONE BLVD
FOREST HILLS NY
11375-1530
US

IV. Provider business mailing address

18628 ABERDEEN RD
JAMAICA NY
11432-5809
US

V. Phone/Fax

Practice location:
  • Phone: 929-577-3376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359900-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: