MEDICARE: DR. MARY C YANKASKAS M.D.

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	207VG0400X	Gynecology Physician	ME61723	FL

General Provider Information

NPI Number	:	1396728770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY C YANKASKAS M.D.

Provider Business Mailing Address
First Line	:	12730 NEW BRITTANY BLVD STE 602
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4690
Country	:	US
Telephone Number	:	239-275-5522
Fax Number	:	239-275-4464

Provider Business Practice Location Address
First Line	:	12730 NEW BRITTANY BLVD STE 602
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4690
Country	:	US
Telephone Number	:	239-275-5522
Fax Number	:	239-275-4464

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	06/24/2020

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