Healthcare Provider Details

I. General information

NPI: 1386997799
Provider Name (Legal Business Name): STEPHEN D YUHAS H.I.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PALM COAST PKWY SW SUITE 109
PALM COAST FL
32137-4746
US

IV. Provider business mailing address

1000 PALM COAST PKWY SW SUITE 109
PALM COAST FL
32137-4746
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-3530
  • Fax: 386-447-3633
Mailing address:
  • Phone: 386-447-3530
  • Fax: 386-447-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: