Provider Demographics
NPI:1598821118
Name:BREVDA, YALE (AUD)
Entity Type:Individual
Prefix:DR
First Name:YALE
Middle Name:
Last Name:BREVDA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7701
Mailing Address - Country:US
Mailing Address - Phone:718-507-5200
Mailing Address - Fax:718-507-7879
Practice Address - Street 1:8715 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7701
Practice Address - Country:US
Practice Address - Phone:718-507-5200
Practice Address - Fax:718-507-7879
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
96001AMedicare ID - Type UnspecifiedMEDICARE