Healthcare Provider Details

I. General information

NPI: 1740968403
Provider Name (Legal Business Name): YAW AMOAKOHENE SARPONG PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GRANBY RD
CHICOPEE MA
01020-1568
US

IV. Provider business mailing address

1109 GRANBY RD
CHICOPEE MA
01020-1568
US

V. Phone/Fax

Practice location:
  • Phone: 833-243-8255
  • Fax:
Mailing address:
  • Phone: 833-243-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2260646
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: