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NPI Code Detail

MEDICARE: AUDRA MICHELLE YADACK M.D.

MEDICARE: AUDRA MICHELLE YADACK M.D.
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
12084P0805XGeriatric Psychiatry Physician32083OK

General Provider Information

NPI Number : 1851611602
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDRA MICHELLE YADACK M.D.
Provider Business Mailing Address
First Line : 450 CLARKSON AVE. SUNY DOWNSTATE MEDICAL CENTER
Second Line : DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
City : NEW YORK CITY
State : NY
Zip : 11203
Country : US
Telephone Number : 718-270-2902
Fax Number :
Provider Business Practice Location Address
First Line : 4601 N CLASSEN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-4815
Country : US
Telephone Number : 405-840-9999
Fax Number : 405-840-9998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2010
Last Update Date : 12/07/2016

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