MEDICARE: YASHEL WEDDERBURN LANDELL MD

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	207Q00000X	Family Medicine Physician	049582	CT
2	207Q00000X	Family Medicine Physician	ME108408	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	:	1245518638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASHEL WEDDERBURN LANDELL MD

Provider Business Mailing Address
First Line	:	225 W HWY 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4980
Country	:	US
Telephone Number	:	407-459-4360
Fax Number	:

Provider Business Practice Location Address
First Line	:	8113 CENTRALIA CT STE 102
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-7521
Country	:	US
Telephone Number	:	877-423-1330
Fax Number	:

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

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	12/17/2019

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