Provider Demographics
NPI:1750902904
Name:NDAO, YOUSSOUPHA
Entity type:Individual
Prefix:MR
First Name:YOUSSOUPHA
Middle Name:
Last Name:NDAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 WHEELER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2306
Mailing Address - Country:US
Mailing Address - Phone:814-404-7278
Mailing Address - Fax:
Practice Address - Street 1:2425 WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5510
Practice Address - Country:US
Practice Address - Phone:718-822-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician