Healthcare Provider Details

I. General information

NPI: 1053841601
Provider Name (Legal Business Name): YOHANCE MANDELA ALLETTE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/15/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOPE DR
HERSHEY PA
17033-2036
US

IV. Provider business mailing address

30 HOPE DRIVE MAIL CODE EC037, SUITE 1300
HERSHEY PA
17033
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-3828
  • Fax:
Mailing address:
  • Phone: 717-531-3828
  • Fax: 717-531-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11019519A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD482394
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: