Provider Demographics
NPI:1982165668
Name:YAKOVENKO, ANASTASIYA D (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIYA
Middle Name:D
Last Name:YAKOVENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANASTASIYA
Other - Middle Name:D
Other - Last Name:YAKOVENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2280 OPITZ BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3362
Mailing Address - Country:US
Mailing Address - Phone:703-523-9750
Mailing Address - Fax:
Practice Address - Street 1:2280 OPITZ BLVD STE 320
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-523-9750
Practice Address - Fax:855-210-2388
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101281658208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery