Individual provider Active NPI

Elvira Yevdayeva, NP

  • Pediatric Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1205606308
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F383448-01 Issued in NY
Practice address
1301 57TH St
Brooklyn, NY 11219-4636
Phone
(718) 283-3640
NPI assigned
Jan 9, 2024
Last updated
Jan 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X F383448-01 NY Primary

Addresses

Primary practice location

1301 57TH St
Brooklyn, NY 11219-4636

Mailing address

825 Ocean Pkwy Apt 4J
Brooklyn, NY 11230-2721
Phone (917) 455-5845

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240503000137 NY Practitioner - Nurse Practitioner 2163862426 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F383448-01NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Faculty Practice Plan CurrentSince Mar 25, 2024 Accepting new patients
MMC Pediatrics Faculty Practice Past Accepting new patients

Locations

1301 57th St
Brooklyn, NY 11219
Phone (718) 283-3640

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

Networks

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

Interoperability endpoints

  • Direct secure messaging: elvira.yevdayeva.p1@direct.mmc.nextgenshare.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1704758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1205606308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 OCEAN PKWY APT 4J",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112302721",
            "telephone_number": "917-455-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 57TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112194636",
            "telephone_number": "718-283-3640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEVDAYEVA",
        "first_name": "ELVIRA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-09",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F383448-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.