Healthcare Provider Details

I. General information

NPI: 1710897665
Provider Name (Legal Business Name): EMILY RACHEL YAGUDAEV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7542 196TH ST
FRESH MEADOWS NY
11366-1844
US

IV. Provider business mailing address

7542 196TH ST
FRESH MEADOWS NY
11366-1844
US

V. Phone/Fax

Practice location:
  • Phone: 718-736-3999
  • Fax:
Mailing address:
  • Phone: 718-736-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: