Healthcare Provider Details

I. General information

NPI: 1447554886
Provider Name (Legal Business Name): YANETSI LANDA-COLON MD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 NE 13TH ST STE B
FORT LAUDERDALE FL
33304-1168
US

IV. Provider business mailing address

4250 GALT OCEAN DR PH H
FORT LAUDERDALE FL
33308-6137
US

V. Phone/Fax

Practice location:
  • Phone: 908-377-9607
  • Fax:
Mailing address:
  • Phone: 908-377-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME109464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number109464
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME109464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: