Provider Demographics
NPI:1427261890
Name:MAYVALDOV, EVGENIA (NP)
Entity type:Individual
Prefix:
First Name:EVGENIA
Middle Name:
Last Name:MAYVALDOV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EVGENIA
Other - Middle Name:
Other - Last Name:TAIBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:189 PRISCILLA RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1817
Mailing Address - Country:US
Mailing Address - Phone:516-661-8352
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3876
Practice Address - Country:US
Practice Address - Phone:516-562-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health