Provider Demographics
NPI:1891131645
Name:MOODY-HENDERSON, YOLANDA ELEASE (BS, MSED, MSSPED)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:ELEASE
Last Name:MOODY-HENDERSON
Suffix:
Gender:F
Credentials:BS, MSED, MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11158 158TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3824
Mailing Address - Country:US
Mailing Address - Phone:347-388-8261
Mailing Address - Fax:
Practice Address - Street 1:11158 158TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3824
Practice Address - Country:US
Practice Address - Phone:347-388-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist