Provider Demographics
NPI:1184456378
Name:URIBE, NOHELY YARASSELL (NP)
Entity type:Individual
Prefix:
First Name:NOHELY
Middle Name:YARASSELL
Last Name:URIBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NOHELY
Other - Middle Name:YARASSELL
Other - Last Name:URIBE BOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10211 ROOSEVELT AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10211 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2331
Practice Address - Country:US
Practice Address - Phone:718-898-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily