Provider Demographics
NPI:1598243610
Name:ALDANA, YESSICA BEATRIZ
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:BEATRIZ
Last Name:ALDANA
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 1:314 N LONG BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1505
Mailing Address - Country:US
Mailing Address - Phone:516-425-2092
Mailing Address - Fax:
Practice Address - Street 1:314 N LONG BEACH AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1505
Practice Address - Country:US
Practice Address - Phone:516-425-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280688-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse