MEDICARE: MRS. MARIYA YANKELEVYCH

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	363L00000X	Nurse Practitioner	ARNP9220388	FL

General Provider Information

NPI Number	:	1083095590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIYA YANKELEVYCH

Provider Business Mailing Address
First Line	:	210 JUPITER LAKES BLVD
Second Line	:	SUITE 4104
City	:	JUPITER
State	:	FL
Zip	:	33458-7191
Country	:	US
Telephone Number	:	561-743-9077
Fax Number	:	561-743-9937

Provider Business Practice Location Address
First Line	:	210 JUPITER LAKES BLVD
Second Line	:	SUITE 4104
City	:	JUPITER
State	:	FL
Zip	:	33458-7191
Country	:	US
Telephone Number	:	561-743-9077
Fax Number	:	561-743-9937

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

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	06/11/2015

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