Provider Demographics
NPI:1467011262
Name:PAGAN, YOLANDA NICOLE
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:NICOLE
Last Name:PAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KYLE CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1531
Mailing Address - Country:US
Mailing Address - Phone:347-784-0281
Mailing Address - Fax:
Practice Address - Street 1:2700 WESTCHESTER AVE STE 300
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2554
Practice Address - Country:US
Practice Address - Phone:914-328-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist