Healthcare Provider Details

I. General information

NPI: 1265509293
Provider Name (Legal Business Name): KERRY ELLYN YAKAWIAK RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MCCLELLAN ST SUITE 103
SCHENECTADY NY
12304-1019
US

IV. Provider business mailing address

700 MCCLELLAN ST STE 103
SCHENECTADY NY
12304-1019
US

V. Phone/Fax

Practice location:
  • Phone: 518-374-2525
  • Fax: 518-374-2533
Mailing address:
  • Phone: 518-374-2525
  • Fax: 518-374-2533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008999
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number008999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: