Provider Demographics
NPI:1386879609
Name:NAYDICH, YELENA (MAC)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:NAYDICH
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 MAIN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3187
Mailing Address - Country:US
Mailing Address - Phone:410-535-2026
Mailing Address - Fax:410-535-1029
Practice Address - Street 1:489 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3187
Practice Address - Country:US
Practice Address - Phone:410-535-2026
Practice Address - Fax:410-535-1029
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01739171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist