MEDICARE: YANTRA PSYCHIATRIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME111271	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528588878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YANTRA PSYCHIATRIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	6700 S FLORIDA AVE STE 33
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3312
Country	:	US
Telephone Number	:	863-450-3067
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 S FLORIDA AVE STE 33
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3312
Country	:	US
Telephone Number	:	863-450-3067
Fax Number	:	863-337-4123

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROSA E NEGRON-MUNOZ
Credential	:	MD
Telephone Number	:	863-450-3067

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	04/25/2022

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