Provider Demographics
NPI:1841448065
Name:CUMMINGS, YLEDEDE MIMI (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:YLEDEDE
Middle Name:MIMI
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1719
Mailing Address - Country:US
Mailing Address - Phone:347-524-2772
Mailing Address - Fax:
Practice Address - Street 1:884 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5940
Practice Address - Country:US
Practice Address - Phone:347-425-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584983163W00000X
NYF307549-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse