Provider Demographics
NPI:1720975634
Name:WILSON, YADIRA (LMT)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:YADIRA
Other - Middle Name:
Other - Last Name:WILSON BINNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 E 17TH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4646
Mailing Address - Country:US
Mailing Address - Phone:929-397-7685
Mailing Address - Fax:
Practice Address - Street 1:598 BROADWAY FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3351
Practice Address - Country:US
Practice Address - Phone:212-539-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist