Provider Demographics
NPI:1083974604
Name:YANOSY, MARIA CAROLINA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CAROLINA
Last Name:YANOSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 REVERE BEACH PKWY # 3
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5923
Mailing Address - Country:US
Mailing Address - Phone:617-389-0099
Mailing Address - Fax:617-294-2612
Practice Address - Street 1:1885 REVERE BEACH PKWY # 3
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5923
Practice Address - Country:US
Practice Address - Phone:617-389-0099
Practice Address - Fax:617-294-2612
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3660156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician