Provider Demographics
NPI:1851611602
Name:YADACK, AUDRA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:MICHELLE
Last Name:YADACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:MICHELLE
Other - Last Name:WENDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:450 CLARKSON AVE. SUNY DOWNSTATE MEDICAL CENTER
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-2902
Mailing Address - Fax:
Practice Address - Street 1:4601 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4815
Practice Address - Country:US
Practice Address - Phone:405-840-9999
Practice Address - Fax:405-840-9998
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK320832084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry