Healthcare Provider Details

I. General information

NPI: 1730513946
Provider Name (Legal Business Name): SISY NOAL-YANES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 SW 76TH ST
SOUTH MIAMI FL
33143-5062
US

IV. Provider business mailing address

2344 SW 24TH ST
MIAMI FL
33145-3616
US

V. Phone/Fax

Practice location:
  • Phone: 786-709-9990
  • Fax:
Mailing address:
  • Phone: 305-456-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: