Provider Demographics
NPI:1902330053
Name:LEBRON, YAMILLETTE
Entity Type:Individual
Prefix:MRS
First Name:YAMILLETTE
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:YAMILLETTE
Other - Middle Name:
Other - Last Name:LEBRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 EAGLE ST APT 342
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-7806
Mailing Address - Country:US
Mailing Address - Phone:347-737-4577
Mailing Address - Fax:
Practice Address - Street 1:27 EAGLE ST APT 342
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-7806
Practice Address - Country:US
Practice Address - Phone:347-737-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1111906171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist