Provider Demographics
NPI:1205411865
Name:VILLALON TORRES, YAYDALI
Entity Type:Individual
Prefix:
First Name:YAYDALI
Middle Name:
Last Name:VILLALON TORRES
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 1:8844A W STATE ROAD 84 STE G10
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4455
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:786-377-5863
Practice Address - Street 1:2277 SW 131ST TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2663
Practice Address - Country:US
Practice Address - Phone:796-985-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily