Healthcare Provider Details

I. General information

NPI: 1003106782
Provider Name (Legal Business Name): ELSHADEY YAYEHYERADE BEKELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

3801 35TH AVE
OAKLAND CA
94619-1433
US

V. Phone/Fax

Practice location:
  • Phone: 301-565-4279
  • Fax:
Mailing address:
  • Phone: 510-220-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD042502
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: