Provider Demographics
NPI:1083166045
Name:BANGURA, YANDAMA
Entity type:Individual
Prefix:
First Name:YANDAMA
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-4704
Mailing Address - Country:US
Mailing Address - Phone:610-304-9554
Mailing Address - Fax:
Practice Address - Street 1:401 NEW KARNER RD STE 301
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3854
Practice Address - Country:US
Practice Address - Phone:838-200-6310
Practice Address - Fax:838-217-7320
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403907363LP0808X
PASP016689363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health