Healthcare Provider Details

I. General information

NPI: 1730375395
Provider Name (Legal Business Name): BRANDON AREA EAR, NOSE AND THROAT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W ROBERTSON ST SUITE 108
BRANDON FL
33511-4934
US

IV. Provider business mailing address

721 W ROBERTSON ST SUITE 108
BRANDON FL
33511-4934
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-4221
  • Fax: 813-653-2442
Mailing address:
  • Phone: 813-684-4221
  • Fax: 813-653-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN L YAVELOW
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 813-684-4221