Provider Demographics
NPI:1578622122
Name:YANTSOS RAY, VALERIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ANN
Last Name:YANTSOS RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:YANTSOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5938 FROND WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2646
Mailing Address - Country:US
Mailing Address - Phone:813-641-0465
Mailing Address - Fax:813-641-0488
Practice Address - Street 1:2001 WEBBER ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5237
Practice Address - Country:US
Practice Address - Phone:941-362-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86922207N00000X, 207ZD0900X, 207ZP0102X
TXQ3427207ZD0900X, 207ZP0102X
NC2020-00493207ZP0102X
LAMD022804207ZP0102X
IDM8087207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273224600Medicaid
FL16802OtherBLUE CROSS BLUE SHIELD
FL16802OtherBLUE CROSS BLUE SHIELD