Provider Demographics
NPI:1568631000
Name:AMPADU-KYERE, YAW (BACHELORS OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:YAW
Middle Name:
Last Name:AMPADU-KYERE
Suffix:
Gender:M
Credentials:BACHELORS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 TUXEDO PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3305
Mailing Address - Country:US
Mailing Address - Phone:973-760-3432
Mailing Address - Fax:
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:MEDICAL STAFF OFFICE, SOUND SHORE MEDICAL CENTER
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5503
Practice Address - Country:US
Practice Address - Phone:914-365-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012032-1363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant