Provider Demographics
NPI:1699920827
Name:PUNCH, YVONNE AGATHA
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:AGATHA
Last Name:PUNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:YVONNE
Other - Middle Name:AGATHA
Other - Last Name:CAESAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3830 PAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469
Mailing Address - Country:US
Mailing Address - Phone:718-882-1212
Mailing Address - Fax:
Practice Address - Street 1:3830 PAULDING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469
Practice Address - Country:US
Practice Address - Phone:718-882-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist