Healthcare Provider Details

I. General information

NPI: 1568116028
Provider Name (Legal Business Name): YARRELL AFI AMETEWEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 N BROADWAY STE 100
MASSAPEQUA NY
11758-1853
US

IV. Provider business mailing address

7 BOOTH ST
CENTEREACH NY
11720-1901
US

V. Phone/Fax

Practice location:
  • Phone: 516-586-8700
  • Fax: 516-586-8701
Mailing address:
  • Phone: 631-575-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027523-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number027523-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: