Healthcare Provider Details

I. General information

NPI: 1588170161
Provider Name (Legal Business Name): JONATHAN MICHAEL YARIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JONATHAN SHAYO MD

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 SW 172ND AVE STE 200
MIRAMAR FL
33029-5592
US

IV. Provider business mailing address

1971 SW 172ND AVE STE 200
MIRAMAR FL
33029-5592
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-2423
  • Fax:
Mailing address:
  • Phone: 954-265-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT2979
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME167413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: