Healthcare Provider Details

I. General information

NPI: 1083291371
Provider Name (Legal Business Name): YAMILEY GEDEON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S DIXIE HWY STE 103
CORAL GABLES FL
33146-3108
US

IV. Provider business mailing address

90 SW 3RD ST APT 3103
MIAMI FL
33130-4060
US

V. Phone/Fax

Practice location:
  • Phone: 786-210-4234
  • Fax:
Mailing address:
  • Phone: 786-277-2706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: