Healthcare Provider Details

I. General information

NPI: 1841266061
Provider Name (Legal Business Name): ALIYA YASIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2676 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-6191
US

IV. Provider business mailing address

2676 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-6191
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-2121
  • Fax: 904-797-2120
Mailing address:
  • Phone: 904-797-2121
  • Fax: 904-797-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME87309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: