Provider Demographics
NPI:1073796637
Name:NI, YONG MEI (MD)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:MEI
Last Name:NI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 DELLCREST PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2302
Mailing Address - Country:US
Mailing Address - Phone:407-416-1401
Mailing Address - Fax:
Practice Address - Street 1:400 N ASHLEY DR
Practice Address - Street 2:STE 1625
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4300
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:813-289-6592
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA1007211363L00000X
FLME126690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIU131ZOtherMCARE MD PTAN
FL001265800Medicaid