Provider Demographics
NPI:1003856279
Name:BOADU, DANIEL YAW (NPP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:YAW
Last Name:BOADU
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14726 230TH PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-4433
Mailing Address - Country:US
Mailing Address - Phone:718-276-7890
Mailing Address - Fax:
Practice Address - Street 1:11 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2017
Practice Address - Country:US
Practice Address - Phone:347-419-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400820363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health