Healthcare Provider Details

I. General information

NPI: 1891600763
Provider Name (Legal Business Name): MADISON LEIGH YOVINO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 N WICKHAM RD STE 306
MELBOURNE FL
32940-2025
US

IV. Provider business mailing address

317 SURF DR
CAPE CANAVERAL FL
32920-2026
US

V. Phone/Fax

Practice location:
  • Phone: 954-465-0669
  • Fax:
Mailing address:
  • Phone: 954-465-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: