MEDICARE: EDMOND YEBOAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	680475	NY

General Provider Information

NPI Number	:	1992121206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMOND YEBOAH

Provider Business Mailing Address
First Line	:	120 CARVER LOOP APT 11C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-2914
Country	:	US
Telephone Number	:	917-615-9780
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 CARVER LOOP APT 11C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-2914
Country	:	US
Telephone Number	:	917-615-9780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	10/03/2023

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Directions to “ EDMOND YEBOAH ” Practice Location

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