Provider Demographics
NPI:1205202488
Name:DAVILA, YASMIN (MS ED , PD IN ASD)
Entity Type:Individual
Prefix:MRS
First Name:YASMIN
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MS ED , PD IN ASD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 WILLETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5518
Mailing Address - Country:US
Mailing Address - Phone:646-326-3109
Mailing Address - Fax:
Practice Address - Street 1:3620 WILLETT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5518
Practice Address - Country:US
Practice Address - Phone:646-326-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist