Healthcare Provider Details

I. General information

NPI: 1497392039
Provider Name (Legal Business Name): YANISLEIDY MONDEJA FNP-C,PMHNP-BC,DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 SUNSET DR STE 105
MIAMI FL
33173-4648
US

IV. Provider business mailing address

9835 SUNSET DR STE 105
MIAMI FL
33173-4648
US

V. Phone/Fax

Practice location:
  • Phone: 786-937-9835
  • Fax: 786-937-9834
Mailing address:
  • Phone: 786-937-9835
  • Fax: 786-937-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005168
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11005168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: