Provider Demographics
NPI:1659994895
Name:SMITH, YASHICA MICKIELA (APN)
Entity Type:Individual
Prefix:MS
First Name:YASHICA
Middle Name:MICKIELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:1434 WILLIAMSBRIDGE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2507
Mailing Address - Country:US
Mailing Address - Phone:718-618-0401
Mailing Address - Fax:347-479-1303
Practice Address - Street 1:2015 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4303
Practice Address - Country:US
Practice Address - Phone:718-299-7295
Practice Address - Fax:718-299-6797
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01034400207Q00000X
NYF346352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine