Healthcare Provider Details

I. General information

NPI: 1306198643
Provider Name (Legal Business Name): YUDELKA A VASQUEZ MS EARLYCHILDHOOD ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 GRAND CONCOURSE APT 1A
BRONX NY
10468-1231
US

IV. Provider business mailing address

3205 GRAND CONCOURSE APT 1A
BRONX NY
10468-1231
US

V. Phone/Fax

Practice location:
  • Phone: 917-557-6806
  • Fax:
Mailing address:
  • Phone: 917-557-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: