Healthcare Provider Details

I. General information

NPI: 1528459997
Provider Name (Legal Business Name): SHAQUENA YLIERET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAGNOLIA LN
WAUCHULA FL
33873-9465
US

IV. Provider business mailing address

654 NE 9TH PL
HOMESTEAD FL
33030-4934
US

V. Phone/Fax

Practice location:
  • Phone: 185-033-9699
  • Fax:
Mailing address:
  • Phone: 305-248-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: