Provider Demographics
NPI:1700227899
Name:ELLIS, YASMINA OSIRIS
Entity Type:Individual
Prefix:
First Name:YASMINA
Middle Name:OSIRIS
Last Name:ELLIS
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 1:3358 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3306
Mailing Address - Country:US
Mailing Address - Phone:646-548-5304
Mailing Address - Fax:
Practice Address - Street 1:3358 HULL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3306
Practice Address - Country:US
Practice Address - Phone:646-548-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency