MEDICARE: DR. YELENA DAVYDOVA DO

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	207Q00000X	Family Medicine Physician	1811968993	NY
2	207Q00000X	Family Medicine Physician	290258	NY

General Provider Information

NPI Number	:	1508267485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YELENA DAVYDOVA DO

Provider Business Mailing Address
First Line	:	800 CORTELYOU RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5243
Country	:	US
Telephone Number	:	718-282-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 CORTELYOU RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5243
Country	:	US
Telephone Number	:	718-282-0900
Fax Number	:

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

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/23/2020

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