Provider Demographics
NPI:1417213299
Name:DASTAIN, JEAN-YVES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-YVES
Middle Name:
Last Name:DASTAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 TAMIAMI TRL NTH
Mailing Address - Street 2:# 104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-234-4482
Mailing Address - Fax:833-563-2420
Practice Address - Street 1:1250 TAMIAMI TRL N STE 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5267
Practice Address - Country:US
Practice Address - Phone:239-234-4482
Practice Address - Fax:833-563-2420
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL139442207R00000X, 207NS0135X
FL142399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03537804Medicaid