Provider Demographics
NPI:1215268818
Name:MUSHIYAKH, YELENA (MD)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:MUSHIYAKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-331-0515
Mailing Address - Fax:215-331-8144
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-331-0515
Practice Address - Fax:215-331-8144
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD450083207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology