Provider Demographics
NPI:1073625133
Name:BEAUVOIR MAYNARD, YANICK (DPM)
Entity Type:Individual
Prefix:
First Name:YANICK
Middle Name:
Last Name:BEAUVOIR MAYNARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4602
Mailing Address - Country:US
Mailing Address - Phone:561-350-6699
Mailing Address - Fax:954-757-7009
Practice Address - Street 1:7857 W SAMPLE RD SUITE 157
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4748
Practice Address - Country:US
Practice Address - Phone:954-775-0168
Practice Address - Fax:954-757-7009
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2784213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65614WOtherMEDICARE ID
FL65614WOtherMEDICARE ID
FLU75463Medicare UPIN