Healthcare Provider Details

I. General information

NPI: 1588304760
Provider Name (Legal Business Name): CASSANDRA B YEBOAH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 CITY AVE
PHILADELPHIA PA
19131-1626
US

IV. Provider business mailing address

6 SPRINGHOUSE CT
BORDENTOWN NJ
08505-4739
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-6380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS023432
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: