Provider Demographics
NPI:1982292090
Name:YEBOAH, KWADWO A
Entity Type:Individual
Prefix:
First Name:KWADWO
Middle Name:A
Last Name:YEBOAH
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 1:786 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3071
Mailing Address - Country:US
Mailing Address - Phone:860-785-8162
Mailing Address - Fax:
Practice Address - Street 1:786 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3071
Practice Address - Country:US
Practice Address - Phone:860-785-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT058471590OtherHOME CARE