Healthcare Provider Details

I. General information

NPI: 1245156421
Provider Name (Legal Business Name): TATYANA UVAYDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21816 PECK AVE
QUEENS VILLAGE NY
11427-1120
US

IV. Provider business mailing address

21816 PECK AVE
QUEENS VILLAGE NY
11427-1120
US

V. Phone/Fax

Practice location:
  • Phone: 917-650-1777
  • Fax:
Mailing address:
  • Phone: 917-650-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number746749
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number746749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: