Provider Demographics
NPI:1164964078
Name:EL-DYSON OTOO, ADRIELLE L A (CNM)
Entity Type:Individual
Prefix:
First Name:ADRIELLE
Middle Name:L A
Last Name:EL-DYSON OTOO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4222
Mailing Address - Country:US
Mailing Address - Phone:718-519-3872
Mailing Address - Fax:
Practice Address - Street 1:84 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4222
Practice Address - Country:US
Practice Address - Phone:646-421-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001769282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital