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General NPI Number Information
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NPI Number | 1003856279
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Entity Type | Individual
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Provider Name | DANIEL YAW BOADU NPP
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 11 W PROSPECT AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2017
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Country | US
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Telephone | 347-419-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 14726 230TH PL
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-4433
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Country | US
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Telephone | 718-276-7890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 400820
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License Number State | NY
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