| Doctor Name: | AVITAL YAGUDAEV |
| NPI Number: | 1164594156 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 009742 |
| Business Practice Address: | 15705 Crossbay Blvd Howard Beach, NY - 114142748 |
| Business Phone Number: | 7188455252 |
| Business Fax Number: | 7188456464 |
| Mailing Address: | 9931 64th Ave, #b14 REGO PARK |
| State: | NY |
| Postal Code: | 113742652 |
| Phone Number: | 7188973940 |
| Fax Number: | |
| NPI Enumeration Date: | 11/14/2006 |
| NPI Last Update Date: | 01/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 009742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |