Provider Demographics
NPI:1598911125
Name:FRAYER, YULONDA THERESA (LICENSED PRACTICAL)
Entity Type:Individual
Prefix:
First Name:YULONDA
Middle Name:THERESA
Last Name:FRAYER
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 TAFT AVENUE
Mailing Address - Street 2:APT. 1008
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206
Mailing Address - Country:US
Mailing Address - Phone:315-218-5371
Mailing Address - Fax:
Practice Address - Street 1:215 EAST AVE
Practice Address - Street 2:
Practice Address - City:MINOA
Practice Address - State:NY
Practice Address - Zip Code:13116
Practice Address - Country:US
Practice Address - Phone:315-863-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288842-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse