Provider Demographics
NPI:1598384307
Name:YADETA, HUNDAOL SHAMSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HUNDAOL
Middle Name:SHAMSAN
Last Name:YADETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 EAST WEST HIGHWAY
Mailing Address - Street 2:APT 468
Mailing Address - City:HYATSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-0002
Mailing Address - Country:US
Mailing Address - Phone:205-370-6965
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.148408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine