Provider Demographics
NPI:1043763683
Name:RESPUS, YAMAYA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MS
First Name:YAMAYA
Middle Name:
Last Name:RESPUS
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 WEBBTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28454-8003
Mailing Address - Country:US
Mailing Address - Phone:910-789-3479
Mailing Address - Fax:
Practice Address - Street 1:1145 WEBBTOWN RD
Practice Address - Street 2:
Practice Address - City:MAPLE HILL
Practice Address - State:NC
Practice Address - Zip Code:28454-8003
Practice Address - Country:US
Practice Address - Phone:910-789-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC 1041301744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1744P3200XMedicare Oscar/Certification