Provider Demographics
NPI:1679030688
Name:NYAMEH, ADJOA NKOA
Entity Type:Individual
Prefix:
First Name:ADJOA
Middle Name:NKOA
Last Name:NYAMEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 VICTORY BLVD APT 2A
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6370
Mailing Address - Country:US
Mailing Address - Phone:347-553-0718
Mailing Address - Fax:
Practice Address - Street 1:2726 VICTORY BLVD APT 2A
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6370
Practice Address - Country:US
Practice Address - Phone:347-553-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY745886-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY702562684Medicaid