Provider Demographics
NPI:1124877881
Name:BEDIAKO, PRINCESS GYABAA
Entity type:Individual
Prefix:
First Name:PRINCESS
Middle Name:GYABAA
Last Name:BEDIAKO
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 1:791 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1869
Mailing Address - Country:US
Mailing Address - Phone:929-286-3466
Mailing Address - Fax:
Practice Address - Street 1:791 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1869
Practice Address - Country:US
Practice Address - Phone:929-286-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY883876163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse