MEDICARE: YESENIA MEDINA

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

General Provider Information

NPI Number	:	1518560358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESENIA MEDINA

Provider Business Mailing Address
First Line	:	1225 SE 24TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-4635
Country	:	US
Telephone Number	:	305-783-9577
Fax Number	:

Provider Business Practice Location Address
First Line	:	4085 HANCOCK BRIDGE PKWY
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7219
Country	:	US
Telephone Number	:	239-677-3767
Fax Number	:

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “ YESENIA MEDINA ” Practice Location

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