Healthcare Provider Details

I. General information

NPI: 1629994249
Provider Name (Legal Business Name): RONIT YAZDAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 TAXTER RD
ELMSFORD NY
10523-2336
US

IV. Provider business mailing address

555 TAXTER RD
ELMSFORD NY
10523-2336
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 999-999-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP138744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: