Provider Demographics
NPI:1720326242
Name:VELAZQUEZ-RODRIGUEZ, YADIRA (MD)
Entity type:Individual
Prefix:DR
First Name:YADIRA
Middle Name:
Last Name:VELAZQUEZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:856-342-2445
Mailing Address - Fax:
Practice Address - Street 1:774 CHRISTIANA ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-731-3017
Practice Address - Fax:302-266-9960
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA091771002084N0400X
PAMD4467262084N0400X
DEC1-00109762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology