Healthcare Provider Details

I. General information

NPI: 1790602183
Provider Name (Legal Business Name): MALIKA YEARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 NEW YORK AVE APT 6E
BROOKLYN NY
11210-6305
US

IV. Provider business mailing address

1368 NEW YORK AVE APT 6E
BROOKLYN NY
11210-6305
US

V. Phone/Fax

Practice location:
  • Phone: 917-244-3142
  • Fax:
Mailing address:
  • Phone: 917-244-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number894295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: