Provider Demographics
NPI:1609802438
Name:PERODIN, YANICK (MD)
Entity Type:Individual
Prefix:
First Name:YANICK
Middle Name:
Last Name:PERODIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 SW 128TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4481
Mailing Address - Country:US
Mailing Address - Phone:786-466-1718
Mailing Address - Fax:305-626-4854
Practice Address - Street 1:16555 NW 25TH AVE
Practice Address - Street 2:NORTH DADE HEALTH CENTER
Practice Address - City:OPALOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054
Practice Address - Country:US
Practice Address - Phone:786-466-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68401500Medicaid
FL68401500Medicaid
FLE22855Medicare UPIN