Healthcare Provider Details

I. General information

NPI: 1063695740
Provider Name (Legal Business Name): YACHT HAVEN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 YACHT HAVEN GRANDE BOX 48
ST THOMAS VI
00802-5004
US

IV. Provider business mailing address

6500 RED HOOK PLZ SUITE 205
ST THOMAS VI
00802-1306
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-1511
  • Fax:
Mailing address:
  • Phone: 340-775-2303
  • Fax: 340-779-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1377
License Number StateVI

VIII. Authorized Official

Name: DR. SIRI AKAL
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 340-775-2303