Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 30493 | TN |
NPI | 1164511085 |
---|---|
Provider Name | Dr. Svetlana Yanishevski |
First Address | Memphis, TN 38117 |
Second Address | Memphis, TN 38117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G89024 | (02) | TN |