Healthcare Provider Details

I. General information

NPI: 1588745327
Provider Name (Legal Business Name): CATHERINE JOAN YEAGLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 MEDICAL PARK DR STE 201
MELBOURNE FL
32901
US

IV. Provider business mailing address

1300 SAWGRASS CORPORATE PKWY STE 200
SUNRISE FL
33323-2823
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-7142
  • Fax: 855-527-5510
Mailing address:
  • Phone: 800-243-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number046018
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME133233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: