Provider Demographics
NPI:1346047602
Name:JEFFERSON-BROWN, NYDA Y
Entity type:Individual
Prefix:
First Name:NYDA
Middle Name:Y
Last Name:JEFFERSON-BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 CROWN POINT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1132
Mailing Address - Country:US
Mailing Address - Phone:402-637-4089
Mailing Address - Fax:
Practice Address - Street 1:3737 CROWN POINT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1132
Practice Address - Country:US
Practice Address - Phone:402-637-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor