Healthcare Provider Details

I. General information

NPI: 1013780840
Provider Name (Legal Business Name): YOLANDA CHAVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 AVENUE J
BROOKLYN NY
11236-3919
US

IV. Provider business mailing address

37 W 48TH ST APT 1
BAYONNE NJ
07002-3578
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-4569
  • Fax: 718-223-4437
Mailing address:
  • Phone: 201-936-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number854654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: