Healthcare Provider Details

I. General information

NPI: 1720498306
Provider Name (Legal Business Name): ASHLEY M YAZDANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY M JULIAN

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 VISCAYA PKWY STE 101
CAPE CORAL FL
33990-3252
US

IV. Provider business mailing address

12730 NEW BRITTANY BLVD STE 602
FORT MYERS FL
33907-4690
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-7337
  • Fax: 239-574-5883
Mailing address:
  • Phone: 239-275-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberOS18997
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS18997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: