Provider Demographics
NPI:1043465347
Name:YANDLE, SUSAN (MD, MPH, MBS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:YANDLE
Suffix:
Gender:F
Credentials:MD, MPH, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 BAYMEADOWS RD E APT 1226
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9108
Mailing Address - Country:US
Mailing Address - Phone:305-785-6722
Mailing Address - Fax:
Practice Address - Street 1:7820 BAYMEADOWS RD E APT 1226
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9108
Practice Address - Country:US
Practice Address - Phone:305-785-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine