Healthcare Provider Details

I. General information

NPI: 1003110180
Provider Name (Legal Business Name): ELLA UVADYEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MINEOLA BLVD STE 200
MINEOLA NY
11501-2530
US

IV. Provider business mailing address

900 MERCHANTS CONCOURSE STE 216
WESTBURY NY
11590-5114
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-4321
  • Fax: 516-741-2502
Mailing address:
  • Phone: 516-226-8373
  • Fax: 844-632-8265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number278083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: