MEDICARE: MRS. YANA S CHEMODANOVA RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	016311	NY

General Provider Information

NPI Number	:	1427398668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YANA S CHEMODANOVA RPA-C

Provider Business Mailing Address
First Line	:	1523 VOORHIES AVE
Second Line	:	5TH FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3912
Country	:	US
Telephone Number	:	718-743-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3912
Country	:	US
Telephone Number	:	718-743-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	09/26/2016

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