Provider Demographics
NPI:1831416510
Name:YEZDANI, MONA (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:YEZDANI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FOULK RD STE F
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3642
Mailing Address - Country:US
Mailing Address - Phone:302-652-8990
Mailing Address - Fax:302-652-8646
Practice Address - Street 1:2000 FOULK RD STE F
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3642
Practice Address - Country:US
Practice Address - Phone:302-652-8990
Practice Address - Fax:302-652-8646
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454801208800000X
DEC10011732208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200172053Medicaid