Provider Demographics
NPI:1053906594
Name:UVAYDOVA, ELLA
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:UVAYDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6443
Mailing Address - Country:US
Mailing Address - Phone:646-752-8916
Mailing Address - Fax:
Practice Address - Street 1:731 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3211
Practice Address - Country:US
Practice Address - Phone:631-656-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI066165-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist