Healthcare Provider Details

I. General information

NPI: 1861944308
Provider Name (Legal Business Name): BEHIYE YENIKOMSU M.S.M., C.P.M.,L.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10268 PARK ROW CT
ORLANDO FL
32832-5868
US

IV. Provider business mailing address

10268 PARK ROW CT
ORLANDO FL
32832-5868
US

V. Phone/Fax

Practice location:
  • Phone: 425-772-6213
  • Fax: 321-319-9713
Mailing address:
  • Phone: 425-772-6213
  • Fax: 321-319-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: