Provider Demographics
NPI:1093496176
Name:YELLOW BIRD PSYCHIATRY & WELLNESS PLLC
Entity Type:Organization
Organization Name:YELLOW BIRD PSYCHIATRY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SALAZAR
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP
Authorized Official - Phone:731-661-1903
Mailing Address - Street 1:1540 INTERNATIONAL PKWY STE 2000
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5096
Mailing Address - Country:US
Mailing Address - Phone:731-661-1903
Mailing Address - Fax:
Practice Address - Street 1:133 HARROGATE PL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4570
Practice Address - Country:US
Practice Address - Phone:731-661-1903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty