Avital Yagudaev, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

009742 Issued in NY

Practice address

15705 Crossbay Blvd
Howard Beach, NY 11414-2748

Phone

(718) 845-5252

Fax

(718) 845-6464

NPI assigned

Nov 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samaritan Medical Services, P.C.

  • Internal Medicine Physician
  • West Islip, NY
  • NPI 1124184544
  Medicare reassignment
• Opty Medical, P.C.

  • Sports Medicine (Family Medicine) Physician
  • Glendale, NY
  • NPI 1023187044
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1164594156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HOWARD ST",
            "city": "EAST WILLISTON",
            "state": "NY",
            "postal_code": "115961420",
            "telephone_number": "917-658-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15705 CROSSBAY BLVD",
            "city": "HOWARD BEACH",
            "state": "NY",
            "postal_code": "114142748",
            "telephone_number": "718-845-5252",
            "fax_number": "718-845-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAGUDAEV",
        "first_name": "AVITAL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "009742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerome Wildes, M.D
• Iyana Wilmott
• Amber Wingfield
• Jean K Woo, RPA-C
• Rupal Ramkumar Yadav
• Richard Yaldizian, MD
• April Yau, RN
• Richard James Yonke, L.AC, L.M.T.
• Brittney Yue
• Peter Louis Zazzarino, D.C.

• Medical Physician Assistant in Howard Beach, NY
• Providers in Howard Beach, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.