=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982165668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANASTASIYA PURITZ YAKOVENKO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2019
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2280 OPITZ BLVD STE 320
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-523-9750
-----------------------------------------------------
Fax | 855-210-2388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2280 OPITZ BLVD STE 320
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-523-9750
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 0101281658
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------