Healthcare Provider Details

I. General information

NPI: 1952366619
Provider Name (Legal Business Name): STEPHEN H YANDEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 CENTURY MEDICAL DR STE B
TITUSVILLE FL
32796-2157
US

IV. Provider business mailing address

845 CENTURY MEDICAL DR STE B
TITUSVILLE FL
32796-2157
US

V. Phone/Fax

Practice location:
  • Phone: 321-529-6202
  • Fax: 321-802-6864
Mailing address:
  • Phone: 321-529-6202
  • Fax: 321-802-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number0102208569
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number34.016906
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS5909
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS5909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: