Healthcare Provider Details

I. General information

NPI: 1629079884
Provider Name (Legal Business Name): BERNARD ADDO-QUAYE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/24/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E CHARLESTON BLVD FL 3
LAS VEGAS NV
89104-1902
US

IV. Provider business mailing address

1721 E CHARLESTON BLVD FL 3
LAS VEGAS NV
89104-1902
US

V. Phone/Fax

Practice location:
  • Phone: 702-685-0620
  • Fax: 702-685-9674
Mailing address:
  • Phone: 702-685-0620
  • Fax: 702-685-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9413
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VALANDO STERLING
Title or Position: OFFICE MANAGER
Credential:
Phone: 702-685-0620