Provider Demographics
NPI:1942021621
Name:GRIGORYEVA, YANA (PA-C)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:GRIGORYEVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-7620
Mailing Address - Country:US
Mailing Address - Phone:203-576-2400
Mailing Address - Fax:
Practice Address - Street 1:126 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-7620
Practice Address - Country:US
Practice Address - Phone:203-576-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant