Healthcare Provider Details

I. General information

NPI: 1063378230
Provider Name (Legal Business Name): MRS. YANICHELLE NOEMI ROSADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PROFESSIONAL PLAZA OFICINA #10 BO. CEIBA BAJA CARR. #2 KM. 118.9
AGUADILLA PR
00603
US

IV. Provider business mailing address

2921 CALLE TABONUCO
PONCE PR
00716-2737
US

V. Phone/Fax

Practice location:
  • Phone: 787-517-0979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8036
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: