Healthcare Provider Details

I. General information

NPI: 1134573652
Provider Name (Legal Business Name): YOULEY TJENDRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-1122
  • Fax: 305-243-5846
Mailing address:
  • Phone: 305-355-1122
  • Fax: 305-243-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME145267
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: