MEDICARE: SOFIA S YAHYA M.D.

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	ME95782	FL

General Provider Information

NPI Number	:	1770540551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA S YAHYA M.D.

Provider Business Mailing Address
First Line	:	325 CLYDE MORRIS BLVD STE 390
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8179
Country	:	US
Telephone Number	:	386-676-6335
Fax Number	:	386-256-7629

Provider Business Practice Location Address
First Line	:	325 CLYDE MORRIS BLVD STE 390
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8179
Country	:	US
Telephone Number	:	386-676-6335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/03/2022

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