MEDICARE: BRANDON A. YEHL RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	011640	NY

General Provider Information

NPI Number	:	1548329741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON A. YEHL RPA-C

Provider Business Mailing Address
First Line	:	105 OAKLAND ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 CANAL VIEW BLVD
Second Line	:	SUITE 102
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2852
Country	:	US
Telephone Number	:	585-461-5330
Fax Number	:	585-461-9895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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