Provider Demographics
NPI:1093382939
Name:ELLIS, YANIQUE TAVIA (MD)
Entity Type:Individual
Prefix:MS
First Name:YANIQUE
Middle Name:TAVIA
Last Name:ELLIS
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:CAYMANAS COUNTRY CLUB EST, LOT F120
Mailing Address - Street 2:DONOVAN CARTER AVE
Mailing Address - City:CAYMANAS BAY
Mailing Address - State:ST. CATHERINE
Mailing Address - Zip Code:JMACE25
Mailing Address - Country:JM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CAYMANAS COUNTRY CLUB EST, LOT F120
Practice Address - Street 2:DONOVAN CARTER AVE
Practice Address - City:CAYMANAS BAY
Practice Address - State:ST. CATHERINE
Practice Address - Zip Code:JMACE25
Practice Address - Country:JM
Practice Address - Phone:876-872-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program