Provider Demographics
NPI:1578288239
Name:FERNANDEZ, YVELLISSE ZAYAS (MS)
Entity Type:Individual
Prefix:MS
First Name:YVELLISSE
Middle Name:ZAYAS
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:YVELLISSE
Other - Middle Name:ZAYAS
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:HC 2 BOX 6999
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9774
Mailing Address - Country:US
Mailing Address - Phone:939-720-4604
Mailing Address - Fax:
Practice Address - Street 1:BO TEJAS SEC ASOMANTE CARR 30 R 921 KM 2 H 2
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9774
Practice Address - Country:US
Practice Address - Phone:939-270-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty