MEDICARE: FAMILY MEDICINE INSTITUTE PROFESSIONAL LIMITED LIABILITY COMPANY

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1912609744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE INSTITUTE PROFESSIONAL LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	15126 SHONAN GOLD DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5684
Country	:	US
Telephone Number	:	718-924-1316
Fax Number	:

Provider Business Practice Location Address
First Line	:	15126 SHONAN GOLD DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-5684
Country	:	US
Telephone Number	:	718-924-1316
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. YASHEL WEDDERBURN LANDELL
Credential	:	MD
Telephone Number	:	407-459-4360

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/21/2023

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