MEDICARE: YASAMIN SARPOOLAKI

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	103K00000X	Behavior Analyst		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134504335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASAMIN SARPOOLAKI

Provider Business Mailing Address
First Line	:	503 RIVERSIDE CIR
Second Line	:
City	:	MELBOURNE BEACH
State	:	FL
Zip	:	32951-2103
Country	:	US
Telephone Number	:	321-514-3265
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 DAIRY RD
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-4046
Country	:	US
Telephone Number	:	214-133-3663
Fax Number	:	321-306-2880

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

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	02/23/2022

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