Healthcare Provider Details

I. General information

NPI: 1649975491
Provider Name (Legal Business Name): TATYANA ALEXANDROVNA YATSENKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 2100
HOUSTON TX
77030-2769
US

IV. Provider business mailing address

333 SCHERMERHORN ST APT 17G
BROOKLYN NY
11217-3492
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-6455
  • Fax:
Mailing address:
  • Phone: 713-715-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: