Healthcare Provider Details

I. General information

NPI: 1629301858
Provider Name (Legal Business Name): ALBERTA DEDE YOHUNO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

IV. Provider business mailing address

728 N MAIN ST
NEW SQUARE NY
10977-8916
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax: 845-517-1975
Mailing address:
  • Phone: 845-354-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342641
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number592788-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number288394-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: