Provider Demographics
NPI:1063664100
Name:YASHAR-AHLA, YAHAWAH-SHA MASHIYACH (LPN)
Entity Type:Individual
Prefix:
First Name:YAHAWAH-SHA
Middle Name:MASHIYACH
Last Name:YASHAR-AHLA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210361
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-0361
Mailing Address - Country:US
Mailing Address - Phone:917-348-7697
Mailing Address - Fax:
Practice Address - Street 1:1055 E 83RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4225
Practice Address - Country:US
Practice Address - Phone:917-348-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269115164W00000X
NY646866163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse