Provider Demographics
NPI:1568116028
Name:AMETEWEE, YARRELL AFI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:YARRELL
Middle Name:AFI
Last Name:AMETEWEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1901
Mailing Address - Country:US
Mailing Address - Phone:631-575-2102
Mailing Address - Fax:
Practice Address - Street 1:1061 N BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1853
Practice Address - Country:US
Practice Address - Phone:516-586-8700
Practice Address - Fax:516-586-8701
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027523-01207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty