Healthcare Provider Details

I. General information

NPI: 1144231580
Provider Name (Legal Business Name): EDUARDO YSERN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 N MAITLAND AVE STE C3
MAITLAND FL
32751-4754
US

IV. Provider business mailing address

331 N MAITLAND AVE STE C3
MAITLAND FL
32751-4754
US

V. Phone/Fax

Practice location:
  • Phone: 407-634-3515
  • Fax:
Mailing address:
  • Phone: 407-634-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: