| Doctor Name: | ELLYN YACKANICZ |
| NPI Number: | 1144693284 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | MA057837 |
| Business Practice Address: | 701 Ostrum St Suite 603 Fountain Hill, PA - 180151155 |
| Business Phone Number: | 4845263990 |
| Business Fax Number: | 6108682915 |
| Mailing Address: | 701 Ostrum St, Suite 603 FOUNTAIN HILL |
| State: | PA |
| Postal Code: | 180151155 |
| Phone Number: | 4845263990 |
| Fax Number: | 6108682915 |
| NPI Enumeration Date: | 11/12/2015 |
| NPI Last Update Date: | 11/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA057837 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |