Provider Demographics
NPI:1114255270
Name:DIAZ, YEDELIS (NP)
Entity Type:Individual
Prefix:MS
First Name:YEDELIS
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5433
Mailing Address - Country:US
Mailing Address - Phone:786-427-9877
Mailing Address - Fax:
Practice Address - Street 1:8870 SW 40TH ST STE 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5465
Practice Address - Country:US
Practice Address - Phone:786-427-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2021-06-30
Deactivation Date:2021-06-04
Deactivation Code:
Reactivation Date:2021-06-30
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005945363LF0000X
FLAS 4392237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist