MEDICARE: Y&M BREATH OF LIFE LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992507446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Y&M BREATH OF LIFE LLC

Provider Business Mailing Address
First Line	:	4612 DAIL RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 DAIL RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2007
Country	:	US
Telephone Number	:	863-602-6457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAYURI PEREZ ACOSTA
Credential	:
Telephone Number	:	863-602-6457

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	03/25/2025

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Directions to “Y&M BREATH OF LIFE LLC ” Practice Location

Language	Start Address	Practice Location

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