MEDICARE: DR. YANDRO LEAL 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	207Q00000X	Family Medicine Physician	ME149377	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME149377	OTHER	FL	FLORIDA LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932690021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANDRO LEAL MD

Provider Business Mailing Address
First Line	:	1912 KINGS HWY STE 700
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-4214
Country	:	US
Telephone Number	:	941-255-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1912 KINGS HWY STE 700
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-4214
Country	:	US
Telephone Number	:	941-255-0032
Fax Number	:

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	09/20/2024

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