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NPI Code Detail

MEDICARE: YENISEY AMADOR MESA

MEDICARE: YENISEY AMADOR MESA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1548091473
Entity Type Code : Individual
Provider Name (Legal Business Name) : YENISEY AMADOR MESA
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 16712 HUFFMEISTER RD BLDG 500
Second Line :
City : CYPRESS
State : TX
Zip : 77429-8050
Country : US
Telephone Number : 281-746-6037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2024
Last Update Date : 05/13/2026

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Directions to “ YENISEY AMADOR MESA ” Practice Location

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