Provider Demographics
NPI:1255122651
Name:MOODLEY, YOGAMBAL MICHELLE
Entity type:Individual
Prefix:MRS
First Name:YOGAMBAL
Middle Name:MICHELLE
Last Name:MOODLEY
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 1:11-602 KENASTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WINNIPEG
Mailing Address - State:MANITOBA
Mailing Address - Zip Code:R3N2A1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11-602 KENASTON BOULEVARD
Practice Address - Street 2:1
Practice Address - City:WINNIPEG
Practice Address - State:MANITOBA
Practice Address - Zip Code:R3N2A1
Practice Address - Country:CA
Practice Address - Phone:204-952-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY539610163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse