Healthcare Provider Details

I. General information

NPI: 1700370004
Provider Name (Legal Business Name): YAFA DAVYDOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 YORK AVENUE 15TH FLOOR
NEW YORK NY
10065
US

IV. Provider business mailing address

3535 W 13 MILE RD
ROYAL OAK MI
48073-6770
US

V. Phone/Fax

Practice location:
  • Phone: 646-697-1533
  • Fax:
Mailing address:
  • Phone: 248-551-3000
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301114788
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number310502
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: