Provider Demographics
NPI:1649239955
Name:MINOTT, YVONNE BRANDON (ANP)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:BRANDON
Last Name:MINOTT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:YVONNE MINOTT
Other - Middle Name:B
Other - Last Name:MINOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:434 HOMESTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1913
Mailing Address - Country:US
Mailing Address - Phone:914-667-3292
Mailing Address - Fax:
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:212-216-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304024-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04114238Medicaid