Provider Demographics
NPI:1619322476
Name:BAFFOUR-AWUAH, NANA YAA ANIMA (MD)
Entity Type:Individual
Prefix:
First Name:NANA YAA
Middle Name:ANIMA
Last Name:BAFFOUR-AWUAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ISLIP AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3225
Mailing Address - Country:US
Mailing Address - Phone:631-277-1616
Mailing Address - Fax:631-277-1804
Practice Address - Street 1:152 ISLIP AVE STE 22
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3225
Practice Address - Country:US
Practice Address - Phone:631-277-1616
Practice Address - Fax:631-277-1804
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine