Healthcare Provider Details

I. General information

NPI: 1316239148
Provider Name (Legal Business Name): STEEVE YAMADJAKO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 NAHANT ST
LYNN MA
01902-3315
US

IV. Provider business mailing address

127 OLD SHORT HILLS RD APT 133
WEST ORANGE NJ
07052-1057
US

V. Phone/Fax

Practice location:
  • Phone: 781-596-0703
  • Fax:
Mailing address:
  • Phone: 781-244-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2379
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: