Healthcare Provider Details

I. General information

NPI: 1285554105
Provider Name (Legal Business Name): MISS YANIKA T BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 WILLOUGHBY AVE APT 4B
BROOKLYN NY
11206-8091
US

IV. Provider business mailing address

570 WILLOUGHBY AVE APT 4B
BROOKLYN NY
11206-8091
US

V. Phone/Fax

Practice location:
  • Phone: 929-773-9770
  • Fax:
Mailing address:
  • Phone: 929-773-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2654398
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: