MEDICARE: DR. SAUDYA YACOOB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS55371	FL

General Provider Information

NPI Number	:	1033626148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAUDYA YACOOB

Provider Business Mailing Address
First Line	:	4042 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4042 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4062
Country	:	US
Telephone Number	:	407-277-4103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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Directions to “ DR. SAUDYA YACOOB ” Practice Location

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