MEDICARE: KEITH I YATTAW PA-C

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	363A00000X	Physician Assistant

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588872824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH I YATTAW PA-C

Provider Business Mailing Address
First Line	:	626 STETSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5837
Country	:	US
Telephone Number	:	407-648-0986
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W SEMINOLE BLVD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-6743
Country	:	US
Telephone Number	:	407-846-2266
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	04/11/2021

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