Provider Demographics
NPI:1144400227
Name:TAESALI, YVONNE BACAY
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:BACAY
Last Name:TAESALI
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 1:4000 COAST GUARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2135
Mailing Address - Country:US
Mailing Address - Phone:757-686-6756
Mailing Address - Fax:
Practice Address - Street 1:7327 HIGHWAY 182 E, 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380
Practice Address - Country:US
Practice Address - Phone:985-397-3287
Practice Address - Fax:985-380-3253
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other