Provider Demographics
NPI:1033672472
Name:DYATLOVA, NATALIIA (MD)
Entity type:Individual
Prefix:
First Name:NATALIIA
Middle Name:
Last Name:DYATLOVA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 BOSTON POST RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3229
Mailing Address - Country:US
Mailing Address - Phone:203-799-1252
Mailing Address - Fax:203-799-3252
Practice Address - Street 1:235 BOSTON POST RD STE 202
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3229
Practice Address - Country:US
Practice Address - Phone:203-799-1252
Practice Address - Fax:203-799-3252
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT79004207RN0300X
IL125.074149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology