MEDICARE: ALIYA YASIN 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	2080A0000X	Pediatric Adolescent Medicine Physician	ME87309	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841266061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIYA YASIN MD

Provider Business Mailing Address
First Line	:	2676 US HIGHWAY 1 S
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6191
Country	:	US
Telephone Number	:	904-797-2121
Fax Number	:	904-797-2120

Provider Business Practice Location Address
First Line	:	2676 US HIGHWAY 1 S
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6191
Country	:	US
Telephone Number	:	904-797-2121
Fax Number	:	904-797-2120

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/12/2007

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