Provider Demographics
NPI:1639210537
Name:YEHUDAH, NAIMYAH CHEDWAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NAIMYAH
Middle Name:CHEDWAH
Last Name:YEHUDAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:NAIMAYAH
Other - Middle Name:CHEDWAH
Other - Last Name:YEHUDAH-COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 POLY PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-836-6600
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1076381363A00000X
NY022518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant