Provider Demographics
NPI:1699430447
Name:OFOSU-YEBOAH, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:OFOSU-YEBOAH
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 1:120 ALCOTT PL APT 27E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4208
Mailing Address - Country:US
Mailing Address - Phone:646-290-1637
Mailing Address - Fax:
Practice Address - Street 1:120 ALCOTT PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4201
Practice Address - Country:US
Practice Address - Phone:646-290-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist