Healthcare Provider Details

I. General information

NPI: 1629384714
Provider Name (Legal Business Name): CECILIA YEBOAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E 25TH ST APT-1F
BROOKLYN NY
11226-7755
US

IV. Provider business mailing address

410 E 25TH ST APT-1F
BROOKLYN NY
11226-7755
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone: 718-671-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number624997
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: