Provider Demographics
NPI:1417993874
Name:AMBROISE, YANSMITH (MD)
Entity Type:Individual
Prefix:
First Name:YANSMITH
Middle Name:
Last Name:AMBROISE
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 1:2718 N ORANGE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7611
Mailing Address - Country:US
Mailing Address - Phone:407-303-2528
Mailing Address - Fax:407-894-9176
Practice Address - Street 1:2718 N ORANGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7611
Practice Address - Country:US
Practice Address - Phone:407-303-2528
Practice Address - Fax:407-894-9176
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95840208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52679OtherBCBS
FL277529800Medicaid
I69099Medicare UPIN
FL277529800Medicaid