Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 400820 | NY |
NPI | 1003856279 |
---|---|
Provider Name | Mr. Daniel Yaw Boadu |
First Address | Springfield Gardens, NY 11413-4433 |
Second Address | Mount Vernon, NY 10550-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 26/04/2021 |