Healthcare Provider Details

I. General information

NPI: 1568924413
Provider Name (Legal Business Name): MAMA MIA MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 CONTESSA DR APT 308
ORLANDO FL
32829-8399
US

IV. Provider business mailing address

6240 CONTESSA DR APT 308
ORLANDO FL
32829-8399
US

V. Phone/Fax

Practice location:
  • Phone: 425-772-6213
  • Fax:
Mailing address:
  • Phone: 425-772-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: BEHIYE YENIKOMSU
Title or Position: LICENSED MIDWIFE, OWNER
Credential: MSM, LM, CPM
Phone: 425-772-6213