Healthcare Provider Details

I. General information

NPI: 1528984085
Provider Name (Legal Business Name): YAMILETH ANA PARRA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 HOMESTEAD AVE
MAYBROOK NY
12543-1337
US

IV. Provider business mailing address

833 HOMESTEAD AVE
MAYBROOK NY
12543-1337
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number352121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: