Provider Demographics
NPI:1134504335
Name:SARPOOLAKI, YASAMIN
Entity Type:Individual
Prefix:
First Name:YASAMIN
Middle Name:
Last Name:SARPOOLAKI
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 1:503 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2103
Mailing Address - Country:US
Mailing Address - Phone:321-514-3265
Mailing Address - Fax:
Practice Address - Street 1:1912 DAIRY RD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4046
Practice Address - Country:US
Practice Address - Phone:214-133-3663
Practice Address - Fax:321-306-2880
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst